Healthcare Provider Details

I. General information

NPI: 1235853615
Provider Name (Legal Business Name): VICTORY PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 AIRPORT BLVD STE 2-413
MOBILE AL
36609-2239
US

IV. Provider business mailing address

3929 AIRPORT BLVD STE 2-413
MOBILE AL
36609-2239
US

V. Phone/Fax

Practice location:
  • Phone: 251-301-1822
  • Fax: 251-301-5571
Mailing address:
  • Phone: 251-301-1822
  • Fax: 251-301-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAREY MCDADE
Title or Position: MD /OWNER
Credential:
Phone: 251-301-1822