Healthcare Provider Details

I. General information

NPI: 1942231105
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF CLEVELAND COUNTY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 N LAFAYETTE ST SUITE 2
SHELBY NC
28150-3834
US

IV. Provider business mailing address

1019 N LAFAYETTE ST SUITE 2
SHELBY NC
28150-3834
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-8282
  • Fax: 704-482-8291
Mailing address:
  • Phone: 704-482-8282
  • Fax: 704-482-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9400695
License Number StateNC

VIII. Authorized Official

Name: MRS. NAJLA AHMED
Title or Position: PHYSICIAN
Credential: MD
Phone: 704-482-8282