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General NPI Number Information
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NPI Number | 1184771636
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Entity Type | Organization
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Legal Business Name | CHILDRENS MEDICAL GROUP P C
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2316 7TH AVE S SUITE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35233-3200
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Country | US
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Telephone | 205-251-4141
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Fax | 205-251-2004
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Provider Business Mailing Address
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Address Line | 2316 7TH AVE S STE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35233-3215
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Country | US
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Telephone | 205-251-4141
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Fax | 205-251-2004
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN LASKER
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Credential |
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Telephone | 205-515-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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