| NPI | 1306965389 |
|---|---|
| Other Name | FAYETTEVILLE PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | JOHNNY EUGENE GASTON Dba 910-488-6331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NC 22112) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |