Provider Demographics
NPI:1982772182
Name:TOTS TO TEENS MEDICAL CENTER
Entity Type:Organization
Organization Name:TOTS TO TEENS MEDICAL CENTER
Other - Org Name:TOTS TO TEENS MEDICAL CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:912-537-9991
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475
Mailing Address - Country:US
Mailing Address - Phone:912-537-9991
Mailing Address - Fax:912-537-9975
Practice Address - Street 1:303 HARRIS INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 1
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474
Practice Address - Country:US
Practice Address - Phone:912-537-9991
Practice Address - Fax:912-537-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty