MEDICARE: CHILTON PEDIATRICS PC

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
1	261QP2300X	Primary Care Clinic/Center	19174	AL

General Provider Information

NPI Number	:	1235299777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILTON PEDIATRICS PC

Provider Business Mailing Address
First Line	:	PO BOX 689
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35046-0689
Country	:	US
Telephone Number	:	205-280-3333
Fax Number	:	205-280-4135

Provider Business Practice Location Address
First Line	:	303 1ST ST N
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-3418
Country	:	US
Telephone Number	:	205-280-3333
Fax Number	:	205-280-4135

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. HERBERT HERRERA
Credential	:
Telephone Number	:	205-280-3333

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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Directions to “CHILTON PEDIATRICS PC ” Practice Location

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