NPI age
20 years
Enumerated 2005-09-20
● Active Type 2 · Organization
Southern Crescent Pediatrics Pc
Southern Crescent Pediatrics Pc is 1 of 2726 pediatrics organizations in Georgia.
Primary specialty
Pediatrics
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Sherwood
President
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 2726 active pediatrics providers in Georgia.
NPI age
20 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2005 → 2026
2005-09Enumerated in NPPES
2005
2026
Where they practice
Primary practice location
191 Fairview Rd
Ellenwood, GA 302942722
Mailing address
150 Medical Blvd, Ste B
Stockbridge, GA 302815053
Authorized official
Juan Jose Sherwood, MD
President
📞 7703899944
Specialties
-
Pediatrics PrimaryA 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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 276714 | BCBS |
| 01 | 7802 | KAISER POS |
| 01 | 0526682 | AETNA SELECT/US HEALTHC |
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.