Healthcare Provider Details

I. General information

NPI: 1427125269
Provider Name (Legal Business Name): GOLDSBORO PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 MEDICAL OFFICE PLACE
GOLDSBORO NC
27534-9460
US

IV. Provider business mailing address

2706 MEDICAL OFFICE PLACE
GOLDSBORO NC
27534-9460
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-4736
  • Fax: 919-580-1017
Mailing address:
  • Phone: 919-734-4736
  • Fax: 919-580-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38877
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ALLEN RIDDICK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-734-4736