Organization
ANNISTON PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANICE CLARK (ADMINISTRATOR)
(256) 237-1618
Entity
Organization
Contact information
Practice address
1001 LEIGHTON AVE, ANNISTON, AL 36207-5782
(256) 237-1618
(256) 237-2661
Mailing address
1001 LEIGHTON AVE, ANNISTON, AL 36207-5782
(256) 237-1618
(256) 237-2661
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00015180
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009931864
—
AL
05
—
009931866
—
AL
01
—
1210952
UNITED HEALTH CARE
AL
01
—
1210953
UNITED HEALTH CARE
AL
05
—
891009700
—
AL
05
—
891009710
—
AL
01
—
F942
BLUE CROSS BLUE SHIELD
AL
Enumeration date
08/14/2006
Last updated
04/01/2011
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