Provider Demographics
NPI:1356456214
Name:GROWING UP PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:GROWING UP PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-995-0899
Mailing Address - Street 1:200 RIVERHILLS BUSINESS PARK
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8112
Mailing Address - Country:US
Mailing Address - Phone:205-995-0899
Mailing Address - Fax:205-995-0451
Practice Address - Street 1:200 RIVERHILLS BUSINESS PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8112
Practice Address - Country:US
Practice Address - Phone:205-995-0899
Practice Address - Fax:205-995-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty