Active NPI
Southeast Pediatrics,P.C.
- Rural Health Clinic/Center
- Tuskegee, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- License
- 11822
- Legal business name
- SOUTHEAST PEDIATRICS,P.C.
- Practice address
- 804 Crawford St
Tuskegee, AL 36083-7262 - Phone
- (334) 724-0550
- Fax
- (334) 724-0591
- NPI assigned
- Sep 27, 2012
- Organization subpart
- Yes
- Parent organization
- SOUTHEAST PEDIATRICS,P.C
NPPES NPI Registry
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.
- Title
- Owner
- Phone
- (334) 724-0550
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 11822 | AL | Primary |
Addresses
Primary practice location
804 Crawford St
Tuskegee, AL 36083-7262
Mailing address
804 Crawford St
Tuskegee, AL 36083-7262
Phone (334) 724-0550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529933919 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130730000180 | AL | Part A Provider - Rural Health Clinic | 3779724075 | Practice locations: Tuskegee, AL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1871844134. Details of each certification follow.
Rural health clinic certification: CCN 018926
- Legal name
- SOUTHEAST PEDIATRICS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 6, 2017
- Last certification
- Mar 19, 2025
- Ownership / control type
- 1A
- Organization structure
- Corporation
- Incorporated
- Jun 22, 2000 in AL
- Enrollment address
- 804 Crawford Street
Tuskegee, AL 36083-7262
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Southeast Pediatrics
- Part of
- Southeast Pediatrics
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatrics Physician
- Tuskegee, AL
- NPI 1790844819
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Mollie a Walker | 5% Or Greater Direct Ownership Interest | Jun 22, 2000 | |
| Mahalia Bryant | W-2 Managing Employee | Jun 22, 2000 |
Practitioners & affiliated clinicians
Practitioners 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348704000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1348704000000",
"number": "1871844134",
"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": "334-724-0550",
"fax_number": "334-724-0591"
},
{
"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": "334-724-0550",
"fax_number": "334-724-0591"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEAST PEDIATRICS,P.C.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHEAST PEDIATRICS,P.C",
"enumeration_date": "2012-09-27",
"last_updated": "2012-09-27",
"status": "A",
"authorized_official_last_name": "WALKER",
"authorized_official_first_name": "MOLLIE",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "334-724-0550",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "AL",
"license": "11822",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "529933919",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tuskegee, AL
- Nguyet H Smith, PHARM.D.
- Shari Smith, LGSW
- Xavier Markies Smith, LMSW
- Eileen M Sordo, PHARMD
- Southeast Pediatrics
- Verna Nicole Sparks-Cooke, LAPSW
- Krishnaswami Srinivasan, MD
- Ashley Stack-Johnston, LGSW
- State of Alabama
- State of Alabama Department of Public Health (Macon County Health Dept Flu-Pneu)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.