Provider Demographics
NPI:1992339246
Name:COMPREHENSIVE PEDIATRICS AND INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PEDIATRICS AND INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:MARQUISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE JARMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-288-3280
Mailing Address - Street 1:430 EMERY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 EMERY DR STE 200
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4595
Practice Address - Country:US
Practice Address - Phone:205-855-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty