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General NPI Number Information
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NPI Number | 1184881237
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CHOICE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 237A E. TAYLOR STREET
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-4053
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Country | US
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Telephone | 931-762-6868
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Fax | 931-762-6869
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Provider Business Mailing Address
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Address Line | 237A E. TAYLOR STREET
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City | LAWRENCEBURG
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State | TN
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Zip | 38464-4053
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Country | US
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Telephone | 931-762-6868
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Fax | 931-762-6869
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELIZABETH HAGAN
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Credential |
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Telephone | 931-762-6868
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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 | 42060
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License Number State | TN
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