Provider Demographics
NPI:1104059039
Name:SOUTHERN PEDIATRICS PLLC
Entity type:Organization
Organization Name:SOUTHERN PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-778-1840
Mailing Address - Street 1:740 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6448
Mailing Address - Country:US
Mailing Address - Phone:615-778-1840
Mailing Address - Fax:615-778-1841
Practice Address - Street 1:740 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6448
Practice Address - Country:US
Practice Address - Phone:615-778-1840
Practice Address - Fax:615-778-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty