Provider Demographics
NPI:1205041555
Name:DAYTON PEDIATRICS P C
Entity Type:Organization
Organization Name:DAYTON PEDIATRICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP
Authorized Official - Phone:423-775-5512
Mailing Address - Street 1:149 WALNUT GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-7925
Mailing Address - Country:US
Mailing Address - Phone:423-775-5512
Mailing Address - Fax:423-775-0155
Practice Address - Street 1:149 WALNUT GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-7925
Practice Address - Country:US
Practice Address - Phone:423-775-5512
Practice Address - Fax:423-775-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445-533 9OtherTN.DEPT.LABOR WORK FORCE