Provider Demographics
NPI:1396497285
Name:SUMTER PEDIATRICS LLC
Entity type:Organization
Organization Name:SUMTER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-924-8082
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0288
Mailing Address - Country:US
Mailing Address - Phone:229-924-8082
Mailing Address - Fax:
Practice Address - Street 1:151 GA HIGHWAY 27 E
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5249
Practice Address - Country:US
Practice Address - Phone:229-924-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMTER PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty