Southeast Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0011822 Issued in AL

Legal business name

SOUTHEAST PEDIATRICS

Practice address

804 Crawford St
Tuskegee, AL 36083-7262

Phone

(334) 724-0350

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mollie Ann Walker, M.D.NPI 1770772923

Title

Offiicer

Phone

(334) 724-0550

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southeast Pediatrics,P.C.

  • Rural Health Clinic/Center
  • Tuskegee, AL
  • NPI 1871844134

  3779724075

  Same PAC ID

Tax ID family

Southeast Pediatricspc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Southeast Pediatrics,P.C.

  • Rural Health Clinic/Center
  • Tuskegee, AL
  • NPI 1871844134
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mollie Ann Walker, M.D.

  • Pediatrics Physician
  • Tuskegee, AL
  • NPI 1770772923
  NPD (past) Authorized official

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790844819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 CRAWFORD ST",
            "city": "TUSKEGEE",
            "state": "AL",
            "postal_code": "360837262",
            "telephone_number": "334-724-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 CRAWFORD ST",
            "city": "TUSKEGEE",
            "state": "AL",
            "postal_code": "360837262",
            "telephone_number": "334-724-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "MOLLIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFIICER",
        "authorized_official_telephone_number": "334-724-0550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "0011822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "0011822",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "5L502423",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leilani Smith, LGSW
• Nguyet H Smith, PHARM.D.
• Shari Smith, LGSW
• Xavier Markies Smith, LMSW
• Eileen M Sordo, PHARMD
• Southeast Pediatrics,P.C.
• Verna Nicole Sparks-Cooke, LAPSW
• Krishnaswami Srinivasan, MD
• Ashley Stack-Johnston, LGSW
• State of Alabama

• Pediatrics Physician in Tuskegee, AL
• Providers in Tuskegee, AL by specialty
• Pediatrics Physician in Alabama

• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.