Organization
MAGNOLIA COMMONS PEDIATRICS LLC
Active
Other names
CARLILE PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D BRUCE (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
78 CAMBRIDGE CT, WETUMPKA, AL 36093-1259
(334) 567-4311
(334) 567-4312
Mailing address
78 CAMBRIDGE CT, WETUMPKA, AL 36093-1259
(334) 567-6915
(334) 514-7269
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
19637
AL
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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