Provider Demographics
NPI:1457590192
Name:MILLINGTON PEDIATRICS, PC
Entity Type:Organization
Organization Name:MILLINGTON PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABUBAKER
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-873-0700
Mailing Address - Street 1:8222 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1708
Mailing Address - Country:US
Mailing Address - Phone:901-873-0700
Mailing Address - Fax:901-873-0711
Practice Address - Street 1:8222 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1708
Practice Address - Country:US
Practice Address - Phone:901-873-0700
Practice Address - Fax:901-873-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN403932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN466407OtherBCBS