NPIMap

Organization Active NPI

Liberty Pediatrics, LLC

  • Pediatrics Physician
  • Vestavia, AL
National Provider Identifier
1629569744
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LIBERTY PEDIATRICS, LLC
Practice address
3735 Corporate Woods Dr Ste 105
Vestavia, AL 35242-2296
Phone
(205) 492-0126
NPI assigned
May 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Authorized official

Name
Mr. Cameron C Deshazo
Title
Owner/Manager
Phone
(205) 492-0126

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

3735 Corporate Woods Dr Ste 105
Vestavia, AL 35242-2296

Mailing address

4387 Boulder Lake Cir
Vestavia, AL 35242-2116
Phone (205) 492-0126

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
01D2328605Liberty Parks Pediatrics3735 Corporate Woods Drive, Suite 105, Vestavia Hills, AL 35242Certificate of waiverAug 12, 2027

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527120000000",
    "number": "1629569744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4387 BOULDER LAKE CIR",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352422116",
            "telephone_number": "205-492-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3735 CORPORATE WOODS DR STE 105",
            "city": "VESTAVIA",
            "state": "AL",
            "postal_code": "352422296",
            "telephone_number": "205-492-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2018-05-24",
        "status": "A",
        "authorized_official_last_name": "DESHAZO",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "205-492-0126",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vestavia, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.