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General NPI Number Information
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NPI Number | 1811995111
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC CLINIC, P.A.
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 940 HOLLY ST NE
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City | ORANGEBURG
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State | SC
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Zip | 29115-4930
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Country | US
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Telephone | 803-536-2725
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Fax | 803-534-1441
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Provider Business Mailing Address
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Address Line | 940 HOLLY ST NE
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City | ORANGEBURG
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State | SC
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Zip | 29115-4930
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Country | US
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Telephone | 803-536-2725
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Fax | 803-534-1441
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PEGGY C. THOMAS
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Credential |
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Telephone | 803-536-2725
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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 | SC
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