Organization
C. EDWIN CHILDERS, JR., MD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARK EDWIN CHILDERS JR. M.D. (PHYSICIAN)
(304) 767-7930
Entity
Organization
Contact information
Practice address
4607 MACCORKLE AVE SW, MP STE 204, SOUTH CHARLESTON, WV 25309-1364
(304) 767-7930
(304) 767-7935
Mailing address
4607 MACCORKLE AVE SW, MP STE 204, SOUTH CHARLESTON, WV 25309-1364
(304) 767-7930
(304) 767-7935
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18115
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109655000
—
WV
Enumeration date
05/21/2007
Last updated
08/22/2020
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