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General NPI Number Information
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NPI Number | 1023024874
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 BRAYTON AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3158
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Country | US
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Telephone | 731-285-4111
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Fax | 731-285-4221
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Provider Business Mailing Address
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Address Line | 1501 BRAYTON AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3158
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Country | US
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Telephone | 731-285-4111
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Fax | 731-285-4221
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAIGE DAVIS
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Credential |
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Telephone | 731-285-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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