=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972243111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH MARSHALL PEDIATRICS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2022
-----------------------------------------------------
Last Update Date | 03/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 MEDICAL PARK DR STE B
-----------------------------------------------------
City | GUNTERSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35976-6999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-860-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 HIGHLAND CREEK CIR
-----------------------------------------------------
City | GUNTERSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35976-2942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-558-9117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | LAURA SNAPP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-302-0940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------