# PEDIATRIC PSYCHIATRIC PROFESSIONAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811719834
- **Authorized official:** CHARLES RANDALE FRITH LCSW (OPERATIONS MANAGER)
- **Authorized official phone:** (318) 527-9322

## Contact information

- **Practice address:** 1661 INTERNATIONAL DR STE 400, MEMPHIS, TN 38120-1431
- **Practice address phone:** (713) 628-8199
- **Practice address fax:** (901) 425-9726
- **Mailing address:** PO BOX 17452, MEMPHIS, TN 38187-0452
- **Mailing address phone:** (318) 527-9322
- **Mailing address fax:** (901) 425-9726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/30/2024
- **Last updated:** 10/30/2024