Healthcare Provider Details

I. General information

NPI: 1821098310
Provider Name (Legal Business Name): AIKEN PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PHYSICIAN DR
AIKEN SC
29801-6388
US

IV. Provider business mailing address

74 PHYSICIAN DR
AIKEN SC
29801-6388
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-2925
  • Fax: 803-649-2788
Mailing address:
  • Phone: 803-649-2925
  • Fax: 803-649-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0505068
License Number StateSC

VIII. Authorized Official

Name: MS. PAULA C. GODWIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-649-2925