Provider Demographics
NPI:1386382273
Name:THE CENTER FOR PEDIATRIC EXCELLENCE, PLLC
Entity type:Organization
Organization Name:THE CENTER FOR PEDIATRIC EXCELLENCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-785-9303
Mailing Address - Street 1:300 STONECREST BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6832
Mailing Address - Country:US
Mailing Address - Phone:629-220-0211
Mailing Address - Fax:629-220-0210
Practice Address - Street 1:300 STONECREST BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6832
Practice Address - Country:US
Practice Address - Phone:629-220-0211
Practice Address - Fax:629-220-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-22
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty