MEDICARE: HAZEL GREEN PEDIATRICS

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1902954597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZEL GREEN PEDIATRICS

Provider Business Mailing Address
First Line	:	PO BOX 2705
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35804-2705
Country	:	US
Telephone Number	:	256-801-6036
Fax Number	:	256-801-6218

Provider Business Practice Location Address
First Line	:	13596 HIGHWAY 231 431 N STE 2
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8618
Country	:	US
Telephone Number	:	256-428-4950
Fax Number	:	256-828-0526

Authorized Official
Title or Position	:	CFO
Name	:	KELLI S POWERS
Credential	:
Telephone Number	:	256-265-8818

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/26/2020

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Directions to “HAZEL GREEN PEDIATRICS ” Practice Location

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