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Organization
PEDIATRIC PSYCHIATRIC PROFESSIONAL LLC
Active
Organization
PEDIATRIC PSYCHIATRIC PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RANDALE FRITH LCSW (OPERATIONS MANAGER)
(318) 527-9322
Entity
Organization
Contact information
Practice address
1661 INTERNATIONAL DR STE 400, MEMPHIS, TN 38120-1431
(713) 628-8199
(901) 425-9726
Mailing address
PO BOX 17452, MEMPHIS, TN 38187-0452
(318) 527-9322
(901) 425-9726
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
10/30/2024
Last updated
10/30/2024
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