Healthcare Provider Details

I. General information

NPI: 1447768718
Provider Name (Legal Business Name): ALEX WADE CHILDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 E MAIN ST STE 7
GRANTSVILLE UT
84029-2501
US

IV. Provider business mailing address

798 S ADAMS AVE
GRANTSVILLE UT
84029-4904
US

V. Phone/Fax

Practice location:
  • Phone: 435-884-3578
  • Fax:
Mailing address:
  • Phone: 435-228-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11261845-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: