MEDICARE: CHILD LIFE PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6499	AL

General Provider Information

NPI Number	:	1033227285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD LIFE PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1398
Second Line	:
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0023
Country	:	US
Telephone Number	:	256-878-7931
Fax Number	:	256-878-7932

Provider Business Practice Location Address
First Line	:	201 W MAIN ST
Second Line	:
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-1627
Country	:	US
Telephone Number	:	256-878-7931
Fax Number	:	256-878-7932

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. MICHAEL ROY SHARPE
Credential	:	M.D.
Telephone Number	:	256-878-7931

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	04/14/2008

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Directions to “CHILD LIFE PEDIATRICS LLC ” Practice Location

Language	Start Address	Practice Location

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