Pediatrician Preference Sheet - Gwinnett Pediatrics and Adolescent

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PLACE LABEL HERE
PEDIATRICIAN PREFERENCE SHEET
I understand that:
1. I am responsible for any bills I receive from the doctor who cares for my baby in the hospital.
2. Not all doctors accept all insurances or self-pay patients.
3. Some doctors may not accept new patients.
Please choose one of the following:
 Dr. ________________________ will care for my baby.
 I do not have a pediatrician for my baby and want Gwinnett Medical Center to get me a doctor.
*Groups with an asterisk do not take Medicaid patients (no exceptions, even if baby has a sibling on Medicaid
and sibling is currently being seen by that pediatrician/group).
______________________________
_______________________
Signature of Patient
Date
Pediatricians Who Attend Newborns at GWP
All About Kids Pediatrics *
Braselton Pediatrics
Buford Pediatrics
CARE Pediatrics
Covenant Family Medicine*
Crescent Pediatrics
Delta Pediatrics
Eastside Pediatrics
Family Care Clinic
Gwinnett Neonatology
Gwinnett Pediatrics *
Assign to Gwinnett
Neonatology
Hamilton Mill Pediatrics
Ivy League Pediatrics
Kaiser Pediatrics*
Kid's Choice Pediatrics
Lawrenceville Pediatrics *
Lilburn Pediatrics
Longstreet Clinic
Mason Children’s Clinic
(Kid’s Clinic)
Medilag Pediatrics, P.C.
Medlock Pediatrics
Millcreek Pediatric Associates
Pediatric Associates L’ville*
Perisseia Physicians
Shah Pediatrics
South Gwinnett Pediatrics
St. Joseph’s Pediatrics *
Stay Well Pediatrics
Sugarloaf Pediatrics
Suwanee Pediatrics
United Pediatrics
Verras Pediatrics
Jill Overcash, MD
Marc-Yriane Borieux, MD
Nirmala S. Bharadwaj, MD
Noelle Ruddock-Solomon, MD
Rene Latoni, MD
William Moneit, MD
Emmanuel Mordi, MD
Muhammad Ali, MD
Renso Fornasini, MD
Leslie Leigh, MD
Shannon Cole, MD
Bridget Duffy, MD
Hal Herd, MD
Joanne Jackson, MD
Suzanne Molock, MD
David Thomson, MD
Nneka C. Unachukwu, MD
Andrew Adam, MD
Candace Kay Greene, MD
Venkateswara Dikkala, MD
Lise Baudean, MD
Charlotte Khan, MD
Vijay Arora, MD
Laura Putnam, MD
Howard Ellis, MD
Divya Joshi, MD
Babatunde I. Onasanya, MD
Maria Batlle, MD
Mabel Njoku, MD
Anna Lawson, MD
David Kunz, MD
May Hawawini, MD
Joyce Lovett, MD
Effie Dolores, MD
Neha Nailesh Soni, MD
Susamma Mathew, MD
Bolaji Odusina, MD
Tayaba Fatema, MD
Athanasios Verras, MD
Henry Moon, MD
Danni Suskin, MD
Yvette Quisling, MD
Lisa Roberts, MD
Susan Smiley, MD
Sharon Steele, MD
George Stickney, MD
Riad Alsayed Amhad, MD
Ashley Stolle, MD
Anna Tanner, MD
Keyana Washington, MD
Monique Welsh-Evans, MD
Tracy Lynn Jimerson, MD
Jaime Pham, MD
Thomas J. Steimer, MD
Tandua O. Washington, MD
James Lin, MD
Melissa Magill, MD
Vicki Morgan, MD
Michael Tim, MD
Sarvpreet Kaur, MD
Anita Khichi, MD
Guna Sekar, MD
Jean Song, MD
Pat Tyagi, MD
Kathryn Benson, MD
Savita Rajgiri, MD
Christian Messick, MD
Anuradha Sheth, MD
Taru Shah, MD
Deepa Mony, MD
THIS SHEET IS FOR INFORMATION ONLY AND NOT A PART OF THE PERMANENT RECORD.
*2-28707*
Page 1 of 2
FORM 2-28707 REVISED 12/13/2012
PLACE LABEL HERE
HOJA DE PREFERENCIA DE LOS PEDIATRAS
PEDIATRICIAN PREFERENCE SHEET
Entiendo que:
1. soy responsable por cualquier factura que reciba del médico que atiende a mi bebé en el hospital;
2. no todos los médicos aceptan todas las compañías de seguros o a pacientes que realizan sus propios
pagos;
3. algunos médicos pueden no aceptar pacientes nuevos.
Elija uno de los siguientes:
 El Dr. ________________________ atenderá a mi bebé.
 No tengo pediatra para mi bebé y quiero que Gwinnett Medical Center me consiga un médico.
*Los grupos con un asterisco no ven pacientes con Medicaid. (No excepciones, aún si el bebé tiene un
hermano(a) con Medicaid, que está siendo atendido por este grupo ó pediatra actualmente)
______________________________
Firma del paciente
_______________________
Fecha
Pediatricians Who Attend Newborns at GWP
All About Kids Pediatrics *
Braselton Pediatrics
Buford Pediatrics
CARE Pediatrics
Covenant Family Medicine*
Crescent Pediatrics
Delta Pediatrics
Eastside Pediatrics
Family Care Clinic
Gwinnett Neonatology
Gwinnett Pediatrics *
Jill Overcash, MD
Marc Yriane Borieux, MD
Nirmala S. Bharadwaj, MD
Noelle Ruddock-Solomon, MD
Rene Latoni, MD
Henry Moon, MD
William Moneit, MD
Emmanuel Mordi, MD
Muhammad Ali, MD
Renso Fornasini
Leslie Leigh, MD
Danni Suskin, MD
Riad Alsayed Amhad, MD
Shannon Cole, MD
Yvette Quisling, MD
Ashley Stolle, MD
Bridget
Duffy,
MD
Lisa
Roberts,
MD
Anna Tanner, MD
Assign to Gwinnett
Hal Herd, MD
Susan Smiley, MD
Keyana Washington, MD
Neonatology
Joanne Jackson, MD
Sharon Steele, MD
Monique Welsh-Evans, MD
Suzanne Molock, MD
George Stickney, MD
Hamilton Mill Pediatrics
David Thomson, MD
Ivy League Pediatrics
NNeka C. Unachukwu, MD
Kaiser Pediatrics
Andrew Adam, MD
Tracy Lynn Jimerson, MD Thomas J. Steimer, MD
Candace Kay Greene, MD
Jaime Pham, MD
Tandua O. Washington, MD
Kid’s Choice Pediatrics
Venkateswara Dikkala, MD
Lawrenceville Pediatrics *
Lise Baudean, MD
James Lin, MD
Vicki Morgan, MD
Charlotte Khan, MD
Melissa Magill, MD
Michael Tim, MD
Lilburn Pediatrics
Vijay Arora, MD
Sarvpreet Kaur, MD
Longstreet Clinic
Laura Putnam, MD
Mason Children’s Clinic
Howard Ellis, MD
Anita Khichi, MD
Jean Song, MD
(Kid’s Clinic)
Divya Joshi, MD
Guna Sekar, MD
Pat Tyagi, MD
Medilag Pediatrics, P.C.
Babatunde I. Onasanya, MD
Medlock Pediatrics
Maria Batlle, MD
Kathryn Benson, MD
Millcreek Pediatric Associates
Mabel Njoku, MD
Savita Rajgiri, MD
Pediatric Associates L’ville *
Anna Lawson, MD
Christian Messick, MD
Anuradha Sheth, MD
Perisseia Physicians
David Kunz, MD
Shah Pediatrics
May Hawawini, MD
Taru Shah, MD
South Gwinnett Pediatrics
Joyce Lovett, MD
St. Joseph’s Pediatrics *
Effie Dolores, MD
Stay Well Pediatrics
Neha Nailesh Soni, MD
Sugarloaf Pediatrics
Susamma Mathew, MD
Deepa Mony, MD
Suwanee Pediatrics
Bolaji Odusina, MD
United Pediatrics
Tayaba Fatema, MD
Verras Pediatrics
Athanasios Verras, MD
THIS SHEET IS FOR INFORMATION ONLY AND NOT A PART OF THE PERMANENT RECORD.
FORM 2-28707 REVISED 12/13/2012
Page 2 of 2
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