Organization
SOUTHERN PEDIATRIC CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLENE C BLACHE M.D. (OWNER/PHYSICIAN)
(229) 241-0059
Entity
Organization
Contact information
Practice address
406 M NORTHSIDE DRIVE, VALDOSTA, GA 31602
(229) 241-0059
(229) 241-0059
Mailing address
406 M NORTHSIDE DRIVE, VALDOSTA, GA 31602
(229) 241-0059
(229) 241-2088
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/06/2008
Last updated
02/03/2017
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