Provider Demographics
NPI:1629495510
Name:THE NEMOURS FOUNDATION
Entity Type:Organization
Organization Name:THE NEMOURS FOUNDATION
Other - Org Name:NEMOURS CHILDREN'S CLINIC GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-697-5628
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:C/O MANAGED CARE DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-5628
Mailing Address - Fax:904-697-5629
Practice Address - Street 1:3025 SHRINE RD STE 350
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4786
Practice Address - Country:US
Practice Address - Phone:912-466-7230
Practice Address - Fax:912-466-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty