Provider Demographics
NPI:1467639534
Name:CENTRAL PEDIATRICS INC.
Entity Type:Organization
Organization Name:CENTRAL PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-233-0712
Mailing Address - Street 1:707 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-3619
Mailing Address - Country:US
Mailing Address - Phone:256-233-0712
Mailing Address - Fax:256-233-3535
Practice Address - Street 1:707 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-3619
Practice Address - Country:US
Practice Address - Phone:256-233-0712
Practice Address - Fax:256-233-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25244305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517667OtherBLUE CROSS BLUE SHIELD AL