Healthcare Provider Details

I. General information

NPI: 1326699190
Provider Name (Legal Business Name): KIDS COVE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5729 COVE COMMONS DRIVE SE SUITE C
BROWNSBORO AL
35741
US

IV. Provider business mailing address

5729 COVE COMMONS DRIVE SE SUITE C
BROWNSBORO AL
35741
US

V. Phone/Fax

Practice location:
  • Phone: 256-367-2686
  • Fax: 256-292-0114
Mailing address:
  • Phone: 256-367-2686
  • Fax: 256-292-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RHONDA B GRAHAM
Title or Position: PEDIATRICIAN
Credential: DO
Phone: 256-367-2686