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General NPI Number Information
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NPI Number | 1356717631
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PREVENTATIVE MEDICAL SERVICES
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 6869 5TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35212-1866
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Country | US
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Telephone | 205-833-9000
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Fax | 205-838-2073
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Provider Business Mailing Address
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Address Line | 6869 5TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35212-1866
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARY HOLDEN JONES
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Credential | MD
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Telephone | 205-552-8691
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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 | 30125
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License Number State | AL
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