Healthcare Provider Details

I. General information

NPI: 1700068293
Provider Name (Legal Business Name): NORTH AUGUSTA PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN COURT
NORTH AUGUSTA SC
29860
US

IV. Provider business mailing address

140 ALLEN COURT
NORTH AUGUSTA SC
29860
US

V. Phone/Fax

Practice location:
  • Phone: 803-510-0007
  • Fax: 803-510-0144
Mailing address:
  • Phone: 803-510-0007
  • Fax: 803-510-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN DAVID ALLEN
Title or Position: OWNER
Credential: M.D.
Phone: 803-510-0007