Healthcare Provider Details

I. General information

NPI: 1891094553
Provider Name (Legal Business Name): THOMASVILLE/ARCHDALE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

IV. Provider business mailing address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-2348
  • Fax: 336-475-2100
Mailing address:
  • Phone: 336-475-2348
  • Fax: 336-475-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LORNA C MCCULLOUGH
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 336-475-4596