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General NPI Number Information
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NPI Number | 1679805493
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Entity Type | Organization
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Legal Business Name | KIDZCARE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 119 EPPERSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3478
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Country | US
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Telephone | 423-745-7500
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Fax | 423-745-7501
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | ATHENS
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State | TN
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Zip | 37371-0925
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Country | US
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Telephone | 423-745-7500
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Fax | 423-745-7501
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SAJI GOPINATHAN
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Credential | M.D.
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Telephone | 423-745-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | MD0000034697
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License Number State | TN
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