Basic Information
| Provider Information | |||||||||
| NPI: | 1275205627 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CARITHERS PEDIATRIC GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7741 POINT MEADOWS DR STE 207 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322569202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043879505 | ||||||||
| FaxNumber: | 9049970155 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 PARK ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322043811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043876200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2021 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | WESTBROOK | ||||||||
| AuthorizedOfficialFirstName: | TIFFANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9043879505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.