NPI age
19 years
Enumerated 2007-03-13
● Active Type 2 · Organization
Kids Time Pediatrics Of Southern Crescent, Llc
Kids Time Pediatrics Of Southern Crescent, Llc is 1 of 138 pediatrics organizations in Georgia.
Primary specialty
Pediatrics
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Clyburn
President
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 138 active pediatrics providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-03Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
115 Sumner Rd, Suite D
Fayetteville, GA 302144758
Mailing address
696 Billups Ave
Madison, GA 306501439
Authorized official
Flynn Clyburn
President
📞 7063422180
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Lillian Cook, DPT Physical Therapist NPI 1942099643
- Gwendolyn Dean, M.D. Specialist NPI 1629028386
- Abdourahman Jallow, DPT, PT Physical Therapist NPI 1104649623
Specialties
-
Pediatrics PrimaryA pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
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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.