Provider Demographics
NPI:1942220389
Name:CHILDREN'S CLINIC EAST
Entity type:Organization
Organization Name:CHILDREN'S CLINIC EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:DOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-7660
Mailing Address - Street 1:3901 CENTRAL PIKE
Mailing Address - Street 2:SUITE 251
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3421
Mailing Address - Country:US
Mailing Address - Phone:615-232-8033
Mailing Address - Fax:
Practice Address - Street 1:3901 CENTRAL PIKE
Practice Address - Street 2:SUITE 251
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3421
Practice Address - Country:US
Practice Address - Phone:615-232-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID