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General NPI Number Information
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NPI Number | 1124356019
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Entity Type | Organization
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Legal Business Name | SALISBURY PEDIATRIC ASSOCIATES, PA
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 17810 STATESVILLE RD SUITE 311
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City | CORNELIUS
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State | NC
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Zip | 28031-8148
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Country | US
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Telephone | 704-655-6300
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Fax | 704-655-7997
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Provider Business Mailing Address
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Address Line | 129 WOODSON ST
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City | SALISBURY
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State | NC
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Zip | 28144-3255
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Country | US
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Telephone | 704-636-5576
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Fax | 704-216-2011
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SHEPARD SEWELL AVERITT IV
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Credential | MED.
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Telephone | 704-216-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NC
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