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General NPI Number Information
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NPI Number | 1457364994
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Entity Type | Organization
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Legal Business Name | ANNISTON PEDIATRICS, INC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 1001 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-5782
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Country | US
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Telephone | 256-237-1618
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Fax | 256-237-2661
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Provider Business Mailing Address
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Address Line | 1001 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-5782
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Country | US
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Telephone | 256-237-1618
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Fax | 256-237-2661
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JANICE CLARK
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Credential |
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Telephone | 256-237-1618
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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 | 00015180
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License Number State | AL
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