Healthcare Provider Details

I. General information

NPI: 1912748914
Provider Name (Legal Business Name): BAY MINETTE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 HAND AVE STE 1
BAY MINETTE AL
36507-4198
US

IV. Provider business mailing address

2305 HAND AVE STE 1
BAY MINETTE AL
36507-4198
US

V. Phone/Fax

Practice location:
  • Phone: 251-239-8198
  • Fax: 251-239-8183
Mailing address:
  • Phone: 251-239-8198
  • Fax: 251-239-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY HODGES
Title or Position: BUSINESS MANAGER
Credential:
Phone: 251-447-3192