Provider Demographics
NPI:1518323518
Name:SOUTHERN PEDIATRICS OF COOL SPRINGS
Entity Type:Organization
Organization Name:SOUTHERN PEDIATRICS OF COOL SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-210-4194
Mailing Address - Street 1:1238 MONARCH WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-210-4194
Mailing Address - Fax:
Practice Address - Street 1:1238 MONARCH WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2621
Practice Address - Country:US
Practice Address - Phone:615-210-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty