Provider Demographics
NPI:1841330057
Name:CHILDRENS CLINIC OF LAGRANGE, LLC
Entity type:Organization
Organization Name:CHILDRENS CLINIC OF LAGRANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:ALMAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-884-2686
Mailing Address - Street 1:1550 DOCTORS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4140
Mailing Address - Country:US
Mailing Address - Phone:706-884-2686
Mailing Address - Fax:706-812-0468
Practice Address - Street 1:1550 DOCTORS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4140
Practice Address - Country:US
Practice Address - Phone:706-884-2686
Practice Address - Fax:706-812-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty