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General NPI Number Information
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NPI Number | 1154915296
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Entity Type | Organization
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Legal Business Name | CARENATION PEDIATRICS
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 205 BRESEE ST
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1134
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Country | US
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Telephone | 615-216-4876
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Fax | 931-299-2952
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Provider Business Mailing Address
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Address Line | 6106 WENDOVER GLN
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City | BRENTWOOD
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State | TN
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Zip | 37027-5740
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Country | US
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Telephone | 615-216-4876
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. MICHAEL GAW
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Credential |
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Telephone | 615-739-3371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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