Healthcare Provider Details

I. General information

NPI: 1164843173
Provider Name (Legal Business Name): SOUTHEND PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ARLINGTON AVE SUITE 510
CHARLOTTE NC
28203-4271
US

IV. Provider business mailing address

PO BOX 31504
CHARLOTTE NC
28231-1504
US

V. Phone/Fax

Practice location:
  • Phone: 704-774-3024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA ALKIRE
Title or Position: MD/OWNER
Credential:
Phone: 704-774-3024