Provider Demographics
NPI:1679805493
Name:KIDZCARE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:KIDZCARE PEDIATRICS, PLLC
Other - Org Name:KIDZCARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPINATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-745-7500
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0925
Mailing Address - Country:US
Mailing Address - Phone:423-745-7500
Mailing Address - Fax:423-745-7501
Practice Address - Street 1:119 EPPERSON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3478
Practice Address - Country:US
Practice Address - Phone:423-745-7500
Practice Address - Fax:423-745-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034697261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health