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NPI Code Detail

MEDICARE: PEDIATRIC CLINIC LLC

MEDICARE: PEDIATRIC CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1134286248
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC CLINIC LLC
Provider Business Mailing Address
First Line : 2401 VILLAGE PROFESSIONAL DRIVE
Second Line :
City : OPELIKA
State : AL
Zip : 36801-4702
Country : US
Telephone Number : 334-749-8121
Fax Number : 334-749-6166
Provider Business Practice Location Address
First Line : 2401 VILLAGE PROFESSIONAL DRIVE
Second Line :
City : OPELIKA
State : AL
Zip : 36801-4702
Country : US
Telephone Number : 334-749-8121
Fax Number : 334-749-6166
Authorized Official
Title or Position : PARTNER
Name : DR. DAVID BRYANT SMALLEY
Credential : M.D.
Telephone Number : 334-749-8121
Provider Enumeration Date : 01/02/2007
Last Update Date : 08/22/2020

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Directions to “PEDIATRIC CLINIC LLC ” Practice Location

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