Provider Demographics
NPI:1689639312
Name:CHILDREN'S MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-342-3810
Mailing Address - Street 1:3920 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2207
Mailing Address - Country:US
Mailing Address - Phone:251-342-3810
Mailing Address - Fax:251-344-6752
Practice Address - Street 1:3920 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2207
Practice Address - Country:US
Practice Address - Phone:251-342-3810
Practice Address - Fax:251-344-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty