Healthcare Provider Details

I. General information

NPI: 1497523625
Provider Name (Legal Business Name): GOLDSBORO PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E RAILROAD STREET
LAGRANGE NC
28551
US

IV. Provider business mailing address

114 E RAILROAD STREET
LAGRANGE NC
28551
US

V. Phone/Fax

Practice location:
  • Phone: 252-566-5999
  • Fax: 252-566-4430
Mailing address:
  • Phone: 252-566-5999
  • Fax: 252-566-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ALLEN RIDDICK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-734-4736