Provider Demographics
NPI:1073548004
Name:ADULT & PEDIATRIC MEDICINE PC
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEATHA
Authorized Official - Middle Name:BARBER
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-284-9772
Mailing Address - Street 1:4825 VIRGINIA LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116
Mailing Address - Country:US
Mailing Address - Phone:334-286-9772
Mailing Address - Fax:334-284-9828
Practice Address - Street 1:4825 VIRGINIA LOOP RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-286-9772
Practice Address - Fax:334-284-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083670Medicaid
AL000083670Medicaid