Provider Demographics
NPI:1104012137
Name:NORTH JEFFERSON PEDIATRICS
Entity Type:Organization
Organization Name:NORTH JEFFERSON PEDIATRICS
Other - Org Name:FADELL SAVANY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FADELL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAVANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-608-1233
Mailing Address - Street 1:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-0952
Mailing Address - Country:US
Mailing Address - Phone:205-608-1222
Mailing Address - Fax:205-608-3848
Practice Address - Street 1:934 GRUBBS AVE
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2637
Practice Address - Country:US
Practice Address - Phone:205-608-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF93530OtherVIVA
AL529900190Medicaid
=========OtherTRICARE