MEDICARE: DECATUR MORGAN PEDIATRICS-RIVERSIDE

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	207Q00000X	Family Medicine Physician	1-10334	AL
2	208000000X	Pediatrics Physician	35949	AL
3	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1508389016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR MORGAN PEDIATRICS-RIVERSIDE

Provider Business Mailing Address
First Line	:	1304 13TH AVE SE STE B
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4316
Country	:	US
Telephone Number	:	256-355-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 13TH AVE SE STE B
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4316
Country	:	US
Telephone Number	:	256-355-1843
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICK HUBLER
Credential	:
Telephone Number	:	256-973-2802

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/21/2022

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Directions to “DECATUR MORGAN PEDIATRICS-RIVERSIDE ” Practice Location

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