Provider Demographics
NPI:1982875530
Name:MORGAN RD PEDIATRICS, PC DBA PEDIATRICS 459
Entity Type:Organization
Organization Name:MORGAN RD PEDIATRICS, PC DBA PEDIATRICS 459
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:DENTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-425-5440
Mailing Address - Street 1:6283 PARK SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5681
Mailing Address - Country:US
Mailing Address - Phone:205-425-5440
Mailing Address - Fax:205-425-5513
Practice Address - Street 1:6283 PARK SOUTH DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5681
Practice Address - Country:US
Practice Address - Phone:205-425-5440
Practice Address - Fax:205-425-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1750329785OtherINDIVIDUAL NPI
AL1750329785OtherINDIVIDUAL NPI