Basic Information
| Provider Information | |||||||||
| NPI: | 1902954597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAZEL GREEN PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568016036 | ||||||||
| FaxNumber: | 2568016218 | ||||||||
| Practice Location | |||||||||
| Address1: | 13596 HIGHWAY 231 431 N STE 2 | ||||||||
| Address2: | |||||||||
| City: | HAZEL GREEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357508618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564284950 | ||||||||
| FaxNumber: | 2568280526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | KELLI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2562658818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.