Organization
GRACE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE P MEDINA MD (SINGLE MEMBER)
(334) 358-5145
Entity
Organization
Contact information
Practice address
74186 TALLASSEE HWY, SUITE B, WETUMPKA, AL 36092-5643
(334) 567-0346
(334) 567-0855
Mailing address
138 BRYAN ST, PRATTVILLE, AL 36066-5348
(334) 358-5145
(334) 358-5145
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22736
AL
Other
Enumeration date
02/09/2007
Last updated
08/22/2020
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