Healthcare Provider Details

I. General information

NPI: 1679529051
Provider Name (Legal Business Name): KIDZCARE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 N MAIN STREET
HOPE MILLS NC
28348
US

IV. Provider business mailing address

PO BOX 9219
FAYETTEVILLE NC
28311-9082
US

V. Phone/Fax

Practice location:
  • Phone: 910-426-7337
  • Fax: 910-424-1418
Mailing address:
  • Phone: 910-483-7337
  • Fax: 910-483-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHANTAE RENEE LOCKHART
Title or Position: CREDENTIALS SPECIALIST
Credential:
Phone: 910-483-7337