Healthcare Provider Details

I. General information

NPI: 1316005481
Provider Name (Legal Business Name): CRITICAL CARE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BIG COVE RD SE
HUNTSVILLE AL
35801-3750
US

IV. Provider business mailing address

PO BOX 2856
HUNTSVILLE AL
35804-2856
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-7946
  • Fax:
Mailing address:
  • Phone: 256-656-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number20693
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number22150
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22150
License Number StateAL

VIII. Authorized Official

Name: MRS. TONJA M WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 256-656-5789