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General NPI Number Information
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NPI Number | 1356453476
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Entity Type | Organization
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Legal Business Name | PITT CHILDREN'S CLINIC, PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 W 5TH ST SUITE 8
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City | GREENVILLE
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State | NC
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Zip | 27834-2888
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Country | US
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Telephone | 252-758-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 W 5TH ST SUITE 8
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City | GREENVILLE
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State | NC
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Zip | 27834-2888
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Country | US
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Telephone | 252-758-1750
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE EDWARD DAVIS
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Credential | MD
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Telephone | 252-758-1750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20383
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License Number State | NC
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