Provider Demographics
NPI:1912219387
Name:PEDIATRICS AT TWILIGHT,LLC
Entity Type:Organization
Organization Name:PEDIATRICS AT TWILIGHT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-220-7988
Mailing Address - Street 1:128 MITYLENE PARK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3758
Mailing Address - Country:US
Mailing Address - Phone:334-220-7988
Mailing Address - Fax:334-279-8214
Practice Address - Street 1:128 MITYLENE PARK LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3758
Practice Address - Country:US
Practice Address - Phone:334-220-7988
Practice Address - Fax:334-279-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630902059Medicaid