Healthcare Provider Details

I. General information

NPI: 1073572822
Provider Name (Legal Business Name): ONSLOW PEDIATRIC ASSOCIATES, 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

51 OFFICE PARK DR
JACKSONVILLE NC
28546-7327
US

IV. Provider business mailing address

51 OFFICE PARK DR
JACKSONVILLE NC
28546-7327
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-5199
  • Fax: 910-577-3424
Mailing address:
  • Phone: 910-577-5199
  • Fax: 910-577-3424

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. JAMES C GANT
Title or Position: PRESIDENT
Credential: M.D., F.A.A.P.
Phone: 910-577-5199