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General NPI Number Information
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NPI Number | 1538501903
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Entity Type | Organization
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Legal Business Name | CAROLINA PEDIATRIC CENTER, PLLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 239 WILMOT DR STE A
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City | GASTONIA
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State | NC
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Zip | 28054-4048
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Country | US
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Telephone | 704-864-0303
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Fax | 704-864-6070
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Provider Business Mailing Address
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Address Line | PO BOX 550818
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City | GASTONIA
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State | NC
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Zip | 28055-0818
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Country | US
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Telephone | 704-864-0303
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OLIVIA B MIJUMBI
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Credential | MD
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Telephone | 704-864-0303
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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 |
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License Number State |
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