Provider Demographics
NPI:1184881237
Name:CHILDREN'S CHOICE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:CHILDREN'S CHOICE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-6868
Mailing Address - Street 1:237A E. TAYLOR STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4053
Mailing Address - Country:US
Mailing Address - Phone:931-762-6868
Mailing Address - Fax:931-762-6869
Practice Address - Street 1:237A E. TAYLOR STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4053
Practice Address - Country:US
Practice Address - Phone:931-762-6868
Practice Address - Fax:931-762-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67241Medicare UPIN