Organization
KIDS CENTRAL PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFFORD DALE JAMES III M.D. (DOCTOR)
(865) 483-5678
Entity
Organization
Contact information
Practice address
575 OAK RIDGE TPKE STE 120, OAK RIDGE, TN 37830-7173
(865) 483-5678
(865) 483-4027
Mailing address
575 OAK RIDGE TPKE STE 120, OAK RIDGE, TN 37830-7173
(865) 483-5678
(865) 483-4027
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD0000033918
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4035193
BLUECARE TENNCARE
TN
Enumeration date
03/07/2007
Last updated
05/30/2008
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