Children's Medical Group PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CHILDREN'S MEDICAL GROUP PA

Practice address

4131 University Blvd S
16
Jacksonville, FL 32216-4326

Phone

(907) 733-7408

Fax

(904) 733-7668

NPI assigned

Nov 10, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Dale Franklin Zimmerman, MD

Title

President

Phone

(907) 268-6725

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932180452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 UNIVERSITY BLVD S",
            "address_2": "16",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164326",
            "telephone_number": "907-733-7408",
            "fax_number": "904-733-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 UNIVERSITY BLVD S",
            "address_2": "16",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164326",
            "telephone_number": "907-733-7408",
            "fax_number": "904-733-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "FRANKLIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-268-6725",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00149",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Children's Home Society of Florida
• Children's Home Society of Florida
• Children's Home Society of Florida
• Children's Home Society of Florida
• Children's Home Society of Florida
• Ani Childress
• Destani Kiara Alexandria Childs
• Genola Childs, MD/MPH
• Mikayla Grace Childs
• Pankaj Paul Chillar, M.D.

• Specialist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Specialist in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.