Provider Demographics
NPI:1972870848
Name:LANIER PEDIATRICS
Entity Type:Organization
Organization Name:LANIER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-1428
Mailing Address - Street 1:4900 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3549
Mailing Address - Country:US
Mailing Address - Phone:334-756-5137
Mailing Address - Fax:
Practice Address - Street 1:4900 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3549
Practice Address - Country:US
Practice Address - Phone:334-756-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty