MEDICARE: ADOLESCENT & PEDIATRIC ASSOCIATES

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	2080A0000X	Pediatric Adolescent Medicine Physician

General Provider Information

NPI Number	:	1063511582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADOLESCENT & PEDIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	2611 WOODLEY PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-3834
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:	334-281-7453

Provider Business Practice Location Address
First Line	:	2611 WOODLEY PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-3834
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:	334-281-7453

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	GLEAN HILL
Credential	:
Telephone Number	:	334-288-0009

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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