Healthcare Provider Details

I. General information

NPI: 1265491997
Provider Name (Legal Business Name): CHILDREN'S HEALTH SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1826 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-329-7337
  • Fax: 252-329-1477
Mailing address:
  • Phone: 252-329-7337
  • Fax: 252-329-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS LYNNE P CHEADLE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 252-329-1474