| Organization Name: | SOUTHERN PEDIATRIC CLLINC LLC |
| NPI Number: | 1982858767 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLENE CARLA BLACHE (OWNER) |
| Mailing Address: | 2601 Bemiss Rd Ste C Valdosta |
| State: | GA US |
| Postal Code: | 316021430 |
| Phone Number: | 2292637050 |
| Fax Number: | 2292634614 |
| NPI Enumeration Date: | 11/06/2008 |
| NPI Last Update Date: | 11/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |