Provider Type Icon

ST. MARY'S MEDICAL GROUP INC. NPI 1588047138


NPI Information

NPI: 1588047138
Provider Name: ST. MARY'S MEDICAL GROUP, INC.

Other Name: HOMETOWN PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D2099553

Address:
1020 JAMESTOWN BLVD
BLDG 200
WATKINSVILLE, GA
ZIP 30677
Phone: (706) 769-0005
Get Directions

ST. MARY'S MEDICAL GROUP, INC. is a pediatrics in Watkinsville, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. ST. MARY'S MEDICAL GROUP, INC. NPI is 1588047138. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Hometown Pediatrics.

The provider's business location address is:

1020 JAMESTOWN BLVD
BLDG 200
WATKINSVILLE, GA
ZIP 30677-131
Phone: (706) 769-0005
Fax: (706) 769-0403

The provider's authorized official is Brittainy Horne .
The authorized official title is President and has the following contact phone number (706) 389-3940.

The CLIA number assigned to this NPI record is 11D2099553 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/1/2015 and was last updated on 11/2/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.