NPIMap

Organization Active NPI

Pediatric Clinic LLC

  • Pediatrics Physician
  • Auburn, AL
National Provider Identifier
1205977089
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC CLINIC LLC
Practice address
760 E Glenn Ave
Auburn, AL 36830-5017
Phone
(334) 749-8121
Fax
(334) 749-6166
NPI assigned
Feb 12, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Bryant Smalley, M.D.NPI 1952468068
Title
Officer
Phone
(334) 749-8121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

760 E Glenn Ave
Auburn, AL 36830-5017

Mailing address

2401 Village Professional Drive
Opelika, AL 36801-4702
Phone (334) 749-8121

Other names 1

  • PEDIATRIC CLINIC Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0914727Pediatric Clinic LLC - Auburn760 E Glenn Ave, Auburn, AL 36830Certificate of waiverAug 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Clinic LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205977089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 VILLAGE PROFESSIONAL DRIVE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368014702",
            "telephone_number": "334-749-8121",
            "fax_number": "334-749-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 E GLENN AVE",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "368305017",
            "telephone_number": "334-749-8121",
            "fax_number": "334-749-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMALLEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRYANT",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "334-749-8121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDIATRIC CLINIC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Auburn, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.