Organization
SOUTHSIDE PEDIATRICS OF AIKEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN CLAUDE COLLINS M.D. (MANAGING PARTNER)
(803) 642-9204
Entity
Organization
Contact information
Practice address
206 CENTRE SOUTH BLVD, AIKEN, SC 29803-6319
(803) 642-9204
(803) 648-3633
Mailing address
206 CENTRE SOUTH BLVD, AIKEN, SC 29803-6319
(803) 642-9204
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11083
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC5204
—
SC
Enumeration date
02/03/2006
Last updated
06/23/2011
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