Organization
PRIME PEDIATRICS LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER CHRISTIAN BLACK PA-C (PHYSICIAN ASSISTANT)
(615) 476-7812
Entity
Organization
Contact information
Practice address
300 S CLYDETON RD, WAVERLY, TN 37185-2140
(615) 476-7812
Mailing address
765 NANCY SHAWL RD, DICKSON, TN 37055-5010
(615) 476-7812
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2021
Last updated
09/28/2021
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