Provider Demographics
NPI:1801851431
Name:GADSDEN PEDIATRIC CLINIC, P.A.
Entity Type:Organization
Organization Name:GADSDEN PEDIATRIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-2894
Mailing Address - Street 1:501 BAY ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5181
Mailing Address - Country:US
Mailing Address - Phone:256-543-2894
Mailing Address - Fax:256-543-8185
Practice Address - Street 1:501 BAY ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5181
Practice Address - Country:US
Practice Address - Phone:256-543-2894
Practice Address - Fax:256-543-8185
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
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty