Provider Demographics
NPI:1366785230
Name:CENTER FOR DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Entity type:Organization
Organization Name:CENTER FOR DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-490-1547
Mailing Address - Street 1:6025 LEE HWY
Mailing Address - Street 2:STE. 447
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3099
Mailing Address - Country:US
Mailing Address - Phone:423-490-1547
Mailing Address - Fax:423-490-1197
Practice Address - Street 1:6025 LEE HWY
Practice Address - Street 2:STE. 447
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3099
Practice Address - Country:US
Practice Address - Phone:423-490-1547
Practice Address - Fax:423-490-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN199072080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty