Provider Demographics
NPI:1326104571
Name:KONATA CHILDS, MD, PLLC
Entity Type:Organization
Organization Name:KONATA CHILDS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-929-8669
Mailing Address - Street 1:10115 CHERRY TREE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4807
Mailing Address - Country:US
Mailing Address - Phone:214-929-8669
Mailing Address - Fax:
Practice Address - Street 1:10115 CHERRY TREE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4807
Practice Address - Country:US
Practice Address - Phone:214-929-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193193301Medicaid
TX193193301Medicaid