Healthcare Provider Details

I. General information

NPI: 1043323439
Provider Name (Legal Business Name): TENNESSEE VALLEY PEDIATRIC ASSOCIATESINC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 KELLER PARK BLVD
TUSCUMBIA AL
35674-1417
US

IV. Provider business mailing address

234 KELLER PARK BLVD
TUSCUMBIA AL
35674-1417
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-6963
  • Fax: 256-381-6018
Mailing address:
  • Phone: 256-381-6963
  • Fax: 256-381-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARMEN SOMERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 256-381-6963