Southern Pediatric Clinic, LLC

NPI #1982858767 in Valdosta, Georgia

Provider Information

NPI Number: 1982858767
Entity Type: Organization
Organization Name: Southern Pediatric Clinic, LLC
Primary Specialty: Pediatrics
Enumeration Date: Nov 6, 2008
Last Updated: Feb 3, 2017

Practice Location

Address: 406 M NORTHSIDE DRIVE
City: Valdosta
State: Georgia
ZIP Code: 31602
Phone: (229) 241-0059

Authorized Official

Name: DR. CHARLENE C BLACHE, M.D.
Title: OWNER/PHYSICIAN
Phone: (229) 241-0059

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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