Provider Demographics
NPI:1356416879
Name:EASTERNSHORE OBGYN
Entity type:Organization
Organization Name:EASTERNSHORE OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-4113
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1134
Mailing Address - Country:US
Mailing Address - Phone:251-928-4113
Mailing Address - Fax:251-928-7177
Practice Address - Street 1:8552 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3696
Practice Address - Country:US
Practice Address - Phone:251-928-4113
Practice Address - Fax:251-928-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTIN