Healthcare Provider Details

I. General information

NPI: 1750345286
Provider Name (Legal Business Name): CHILDREN'S HEALTH OF CAROLINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CANDY PARK RD
PEMBROKE NC
28372-9129
US

IV. Provider business mailing address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-0201
  • Fax: 910-521-0773
Mailing address:
  • Phone: 910-738-8060
  • Fax: 910-671-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA F SEALY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 910-739-3318