Provider Demographics
NPI:1508047697
Name:NAKI PEDIATRICS & ADOLESCENT
Entity Type:Organization
Organization Name:NAKI PEDIATRICS & ADOLESCENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-0111
Mailing Address - Street 1:410 BAY ST
Mailing Address - Street 2:NAKI PEDIATRICS & ADOLESCENT HEALTH CENTER, PC
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-0000
Mailing Address - Country:US
Mailing Address - Phone:256-543-0111
Mailing Address - Fax:256-543-2907
Practice Address - Street 1:410 BAY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5108
Practice Address - Country:US
Practice Address - Phone:256-543-0111
Practice Address - Fax:256-543-2907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAKI PEDIATRICS & ADOLESCENT HEALTH CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-17
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL82822080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529902470Medicaid
AL51020868OtherBCBS