Provider Demographics
NPI:1972723567
Name:PRIMARY CARE PEDIATRICS
Entity type:Organization
Organization Name:PRIMARY CARE PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:SKINNER
Authorized Official - Last Name:ALGEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-873-4242
Mailing Address - Street 1:8222 HIGHWAY 51 NORTH
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-873-4242
Mailing Address - Fax:901-873-4269
Practice Address - Street 1:8222 HIGHWAY 51 NORTH
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-873-4242
Practice Address - Fax:901-873-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3199589Medicaid
TN3199589Medicaid