Organization
SOUTHEAST PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOLLIE ANN WALKER M.D. (OFFIICER)
(334) 724-0550
Entity
Organization
Contact information
Practice address
804 CRAWFORD ST, TUSKEGEE, AL 36083-7262
(334) 724-0350
Mailing address
804 CRAWFORD ST, TUSKEGEE, AL 36083-7262
(334) 724-0350
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0011822
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011822
LICENSE NUMBER
AL
01
—
5L502423
BLUECROSS
AL
Enumeration date
12/06/2006
Last updated
08/22/2020
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