Healthcare Provider Details

I. General information

NPI: 1497877427
Provider Name (Legal Business Name): PEDIATRIC PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 VICKERY LN
CORDOVA TN
38016-1619
US

IV. Provider business mailing address

1172 VICKERY LN
CORDOVA TN
38016-1619
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-0095
  • Fax: 901-754-4838
Mailing address:
  • Phone: 901-757-0095
  • Fax: 901-754-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID MATTHEW ZIEBARTH
Title or Position: SECRETARY-TREASURER
Credential: M.D.
Phone: 901-757-0095