Healthcare Provider Details

I. General information

NPI: 1447437785
Provider Name (Legal Business Name): SOUTHMOUNTAIN CHILDREN AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S GREEN ST
MORGANTON NC
28655-3529
US

IV. Provider business mailing address

PO BOX 3387
MORGANTON NC
28680-3387
US

V. Phone/Fax

Practice location:
  • Phone: 828-430-9949
  • Fax: 828-433-1268
Mailing address:
  • Phone: 828-391-2803
  • Fax: 828-584-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. W. CHRIS JERNIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-584-1105