Prime Pediatrics LLP

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PRIME PEDIATRICS LLP

Practice address

300 S Clydeton Rd
Waverly, TN 37185-2140

Phone

(615) 476-7812

NPI assigned

Sep 20, 2021

Last updated

Sep 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexander Christian Black, PA-C

Title

Physician Assistant

Phone

(615) 476-7812

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1881364941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 NANCY SHAWL RD",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370555010",
            "telephone_number": "615-476-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S CLYDETON RD",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852140",
            "telephone_number": "615-476-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PEDIATRICS LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "CHRISTIAN",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "615-476-7812",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pharmhouse LLC (Trull Family Pharmacy)
• Pharmhouse LLC (Trull Family Pharmacy Long-Term Care)
• Phipps Pharmacy Inc (Phipps Pharmacy Waverly)
• Mary Katherine Poglitsch, PTA
• Premier Care Pediatrics (Nestor A. Ojeda, MD)
• Tonya Michelle Reynoldson, OD
• Frances Geraldine Rich, LPC
• Michael Richardson, PHARMD
• Richland Creek Dental Group, PLLC (East Hills Dental Center - Waverly)
• River Valley Eye Clinic P C

• Primary Care Clinic/Center in Waverly, TN
• Providers in Waverly, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.