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General NPI Number Information
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NPI Number | 1881364941
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Entity Type | Organization
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Legal Business Name | PRIME PEDIATRICS LLP
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 300 S CLYDETON RD
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City | WAVERLY
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State | TN
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Zip | 37185-2140
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Country | US
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Telephone | 615-476-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 765 NANCY SHAWL RD
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City | DICKSON
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State | TN
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Zip | 37055-5010
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Country | US
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Telephone | 615-476-7812
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | ALEXANDER CHRISTIAN BLACK
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Credential | PA-C
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Telephone | 615-476-7812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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