Healthcare Provider Details

I. General information

NPI: 1942267943
Provider Name (Legal Business Name): KINSTON OBSTETRICAL & GYNECOLOGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KINSTON CLINIC NORTH SUITE E DOCTORS DRIVE
KINSTON NC
28501-1598
US

IV. Provider business mailing address

KINSTON CLINIC NORTH SUITE E DOCTORS DRIVE
KINSTON NC
28501-1598
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-4333
  • Fax: 252-522-2951
Mailing address:
  • Phone: 252-522-4333
  • Fax: 252-522-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38975
License Number StateNC

VIII. Authorized Official

Name: SUSAN K HAND
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 252-522-4333