Provider Demographics
NPI:1508389016
Name:DECATUR MORGAN PEDIATRICS-RIVERSIDE
Entity Type:Organization
Organization Name:DECATUR MORGAN PEDIATRICS-RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-973-2802
Mailing Address - Street 1:1304 13TH AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4316
Mailing Address - Country:US
Mailing Address - Phone:256-355-1843
Mailing Address - Fax:
Practice Address - Street 1:1304 13TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4316
Practice Address - Country:US
Practice Address - Phone:256-355-1843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-10334207Q00000X
AL35949208000000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty