Healthcare Provider Details

I. General information

NPI: 1982240941
Provider Name (Legal Business Name): HERITAGE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3358 HIGHWAY 280 SUITE 108
ALEXANDER CITY AL
35010
US

IV. Provider business mailing address

PO BOX 2040
ALEXANDER CITY AL
35011-2040
US

V. Phone/Fax

Practice location:
  • Phone: 256-794-8007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHANTE RUFFIN
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 256-794-8007