VIBRANT KIDS PEDIATRICS, LLC
NPI 1811241417
Clinic/Center in Newnan, GA

NPI Status: Active since November 04, 2012

Contact Information

10 MARKET SQUARE WAY STE 100
NEWNAN, GA
ZIP 30265
Phone: (678) 423-5560
Fax: (678) 423-5563

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  • Organization
  • Clinic/Center
  • CLIA Number: 11D2051267
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 12-16-2026

About VIBRANT KIDS PEDIATRICS, LLC

This page provides the complete NPI Profile along with additional information for Vibrant Kids Pediatrics, Llc, a provider established in Newnan, Georgia operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1811241417 assigned on November 2012. The practitioner's primary taxonomy code is 261Q00000X with license number 061061 (GA). The provider is registered as an organization and their NPI record was last updated 14 years ago. The authorized official of this NPI record is Jill Burnett Dickerson Md (Manager)

NPI
1811241417
Provider Name
VIBRANT KIDS PEDIATRICS, LLC
Entity Type
Organization
Location Address
10 MARKET SQUARE WAY STE 100 NEWNAN, GA 30265
Location Phone
(678) 423-5560
Location Fax
(678) 423-5563
Mailing Address
87 TAPESTRY LN NEWNAN, GA 30265
Mailing Phone
(678) 423-5560
Mailing Fax
(678) 423-5563
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-04-2012
Last Update Date
11-04-2012
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center

Taxonomy Code
261Q00000X
Type
Ambulatory Health Care Facilities
License No.
061061
License State
GA
Taxonomy Description
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

JILL BURNETT DICKERSON MD

Authorized Official Title
MANAGER
Authorized Official Phone
(678) 423-5560

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
11D2051267
Facility Type
Physician Office
Certificate Effective Date
December 17, 2024
Certificate Expiration Date
December 16, 2026
Laboratory Director
JILL B. DICKERSON
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Vibrant Kids Pediatrics, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1811241417, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
8
Unchanged
Pos 3
1
Doubled → 2
Pos 4
1
Unchanged
Pos 5
2
Doubled → 4
Pos 6
4
Unchanged
Pos 7
1
Doubled → 2
Pos 8
4
Unchanged
Pos 9
1
Doubled → 2
Check
7
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 1 → 2 2 → 4 1 → 2 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 2 + 1 + 4 + 4 + 2 + 4 + 2 + 24 = 53

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 53 is 60. The difference is the calculated check digit.

60 - 53 = 7
This NPI is valid
The calculated check digit is 7, which matches the last digit of 1811241417.

Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Pediatrics
10 MARKET SQUARE WAY STE 100
NEWNAN, GA 30265

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1811241417, enumerated as an "organization" on November 04, 2012.

The provider is located at 10 MARKET SQUARE WAY STE 100 NEWNAN, GA 30265 and the phone number is (678) 423-5560.

Clinic/Center with taxonomy code 261Q00000X.