Provider Demographics
NPI:1851628697
Name:CLANTON PEDIATRICS OF ALABAMA PC
Entity Type:Organization
Organization Name:CLANTON PEDIATRICS OF ALABAMA PC
Other - Org Name:CHILTON PEDIATRICS OF ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS ELEANOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALOLOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-280-3333
Mailing Address - Street 1:303 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3418
Mailing Address - Country:US
Mailing Address - Phone:205-280-3333
Mailing Address - Fax:205-280-4135
Practice Address - Street 1:303 1ST ST N
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3418
Practice Address - Country:US
Practice Address - Phone:205-280-3333
Practice Address - Fax:205-280-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty