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General NPI Number Information
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NPI Number | 1821419508
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Entity Type | Organization
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Legal Business Name | KIDZCARE PEDIATRICS, PC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 5244B N SHARON AMITY RD
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City | CHARLOTTE
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State | NC
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Zip | 28215-0053
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Country | US
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Telephone | 704-536-0073
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Fax | 704-535-5722
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Provider Business Mailing Address
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Address Line | PO BOX 647
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City | HOPE MILLS
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State | NC
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Zip | 28348-0647
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Country | US
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Telephone | 910-483-7337
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Fax | 910-483-0648
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Authorized Official
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Title or Position | CREDENTIALS MANAGER
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Name | MS. REBECCA E WRIGHT
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Credential |
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Telephone | 910-483-7337
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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 | 118386
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License Number State | NC
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