Healthcare Provider Details

I. General information

NPI: 1427018894
Provider Name (Legal Business Name): THOMASVILLE-ARCHDALE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
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 Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CLINT TAYLOR
Title or Position: MEDICAL PRACTICE ADMINISTRATOR
Credential:
Phone: 336-476-9446