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General NPI Number Information
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NPI Number | 1316714512
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRICS WEST LLC
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 400 19TH ST E
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City | JASPER
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State | AL
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Zip | 35501-5416
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Country | US
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Telephone | 205-936-8107
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Fax | 205-512-2548
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Provider Business Mailing Address
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Address Line | 400 19TH ST E
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City | JASPER
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State | AL
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Zip | 35501-5416
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Country | US
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Telephone | 205-936-8107
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Fax | 205-512-2548
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Authorized Official
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Title or Position | CERTIFIED RN PRACTITIONER
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Name | MRS. LEAH VARDEN GANN
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Credential | CRNP
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Telephone | 205-936-8107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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