Healthcare Provider Details

I. General information

NPI: 1184771636
Provider Name (Legal Business Name): CHILDRENS MEDICAL GROUP P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 7TH AVE S SUITE 100
BIRMINGHAM AL
35233-3200
US

IV. Provider business mailing address

2316 7TH AVE S STE 100
BIRMINGHAM AL
35233-3215
US

V. Phone/Fax

Practice location:
  • Phone: 205-251-4141
  • Fax: 205-251-2004
Mailing address:
  • Phone: 205-251-4141
  • Fax: 205-251-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LASKER
Title or Position: OWNER
Credential:
Phone: 205-515-0538