Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Decatur Pediatric Group, PA

Organization Pediatrics Physician · NPI 1619029592

Decatur Pediatric Group, PA is a Pediatrics Physician in Clarkston, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4112 E Ponce De Leon Ave
Clarkston, GA 30021-1817
Phone: (404) 296-7133
Fax: (404) 296-7211
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 038132 (GA)

Record details

NPI number1619029592
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lynette Wilson-Phillips — President · (404) 296-7133
NPI enumeratedJanuary 18, 2007
Last updated in NPPESAugust 22, 2020
Mailing address4112 E Ponce De Leon Ave, Clarkston, GA 30021-1817

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