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Organization
PEDIATRIC CLINIC LLC
Active
Organization
PEDIATRIC CLINIC LLC
Active
Parent organization
PEDIATRIC CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC CLINIC LLC
Authorized official
JERRY PASCHAL HAYNES (ADMINISTRATOR)
(334) 749-8121
Entity
Organization
Contact information
Practice address
2375 CHAMPIONS BLVD STE 3, AUBURN, AL 36830-6471
(334) 749-8121
(334) 749-6166
Mailing address
2401 VILLAGE PROFESSIONAL DR S, OPELIKA, AL 36801-4702
(334) 749-8121
(334) 749-6166
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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