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Contact Information

SOUTHERN PEDIATRIC CLINIC, LLC
406 M NORTHSIDE DRIVE
VALDOSTA, GA31602
 Phone: 229-241-0059
 Fax: 229-241-0059
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for SOUTHERN PEDIATRIC CLINIC, LLC

NPI Number 1982858767
LBN Legal business name SOUTHERN PEDIATRIC CLINIC, LLC
Authorized official CHARLENE BLACHE - (OWNER/PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 11/06/2008
Last updated 02/03/2017 - About 9 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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