Healthcare Provider Details

I. General information

NPI: 1972658797
Provider Name (Legal Business Name): ALL CHILDREN'S PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 N PARIS AVE
PORT ROYAL SC
29935-2029
US

IV. Provider business mailing address

1875 N PARIS AVE
PORT ROYAL SC
29935-2029
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-3870
  • Fax: 843-522-0691
Mailing address:
  • Phone: 843-522-3870
  • Fax: 843-522-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES SIMMONS
Title or Position: M.D.
Credential:
Phone: 843-522-3870