Provider Demographics
NPI:1801130497
Name:ANNISTON PEDIATRICS INC
Entity type:Organization
Organization Name:ANNISTON PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:CARPENTER
Authorized Official - Last Name:DOGGETT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:256-237-1618
Mailing Address - Street 1:1001 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5701
Mailing Address - Country:US
Mailing Address - Phone:256-237-1618
Mailing Address - Fax:256-237-2661
Practice Address - Street 1:1001 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5701
Practice Address - Country:US
Practice Address - Phone:256-237-1618
Practice Address - Fax:256-237-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1851A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty