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General NPI Number Information
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NPI Number | 1356416879
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Entity Type | Organization
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Legal Business Name | EASTERNSHORE OBGYN
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8552 MORPHY AVE
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City | FAIRHOPE
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State | AL
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Zip | 36532-3696
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Country | US
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Telephone | 251-928-4113
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Fax | 251-928-7177
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Provider Business Mailing Address
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Address Line | PO BOX 1134
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City | FAIRHOPE
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State | AL
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Zip | 36533-1134
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Country | US
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Telephone | 251-928-4113
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Fax | 251-928-7177
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MITZI M CHILDS
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Credential | MD
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Telephone | 251-928-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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