Healthcare Provider Details
I. General information
NPI: 1437236338
Provider Name (Legal Business Name): ONSLOW HEALTH ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/01/2006
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1201 COUNTRY CLUB ROAD
JACKSONVILLE NC
28546
US
IV. Provider business mailing address
504 SARAH COURT
JACKSONVILLE NC
28540
US
V. Phone/Fax
- Phone: 910-347-7773
- Fax: 910-347-7792
- Phone: 910-347-7773
- Fax: 910-347-7792
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 23340 |
| License Number State | NC |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
STANLEY
DOUGLAS
TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 910-340-7773