Provider Demographics
NPI:1033227285
Name:CHILD LIFE PEDIATRICS LLC
Entity Type:Organization
Organization Name:CHILD LIFE PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-878-7931
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0023
Mailing Address - Country:US
Mailing Address - Phone:256-878-7931
Mailing Address - Fax:256-878-7932
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1627
Practice Address - Country:US
Practice Address - Phone:256-878-7931
Practice Address - Fax:256-878-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC36327Medicare UPIN