Provider Demographics
NPI:1104047075
Name:THE PEDIATRIC CENTER LLC
Entity type:Organization
Organization Name:THE PEDIATRIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-226-7544
Mailing Address - Street 1:PO BOX 2258
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2258
Mailing Address - Country:US
Mailing Address - Phone:229-226-7544
Mailing Address - Fax:229-226-0314
Practice Address - Street 1:980 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3064
Practice Address - Country:US
Practice Address - Phone:229-377-8560
Practice Address - Fax:229-377-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care