Healthcare Provider Details

I. General information

NPI: 1073548004
Provider Name (Legal Business Name): ADULT & PEDIATRIC MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 VIRGINIA LOOP RD
MONTGOMERY AL
36116
US

IV. Provider business mailing address

4825 VIRGINIA LOOP RD
MONTGOMERY AL
36116
US

V. Phone/Fax

Practice location:
  • Phone: 334-286-9772
  • Fax: 334-284-9828
Mailing address:
  • Phone: 334-286-9772
  • Fax: 334-284-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEATHA BARBER MORGAN
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 334-284-9772