Provider Demographics
NPI:1528899598
Name:SOUTHERN CHARM PEDIATRICS
Entity type:Organization
Organization Name:SOUTHERN CHARM PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:214-551-1268
Mailing Address - Street 1:105 N ALMA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3359
Mailing Address - Country:US
Mailing Address - Phone:214-551-1268
Mailing Address - Fax:
Practice Address - Street 1:105 N ALMA DR STE 300
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3359
Practice Address - Country:US
Practice Address - Phone:214-551-1268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty