NPI 1013280486

Magnolia Commons Pediatrics LLC

Organisation Pediatric Adolescent Medicine Physician Wetumpka, AL

Practice location

Address: 78 Cambridge CT, Wetumpka, AL 36093-1259
Phone: (334) 567-4311
Fax: (334) 567-4312

Authorised official

Name: Michael D Bruce
Title: Ceo
Phone: (334) 567-4311

Registered specialties

Pediatric Adolescent Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2080A0000X Licence 19637 (AL)

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Registry record

NPI: 1013280486
Entity type: Organization
NPI issued: 16 Feb 2012
Record last updated: 16 Feb 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.