| NPI | 1760865760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTAE RENEE LOCKHART Credentialing Coordinator 910-483-7337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 118386) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2022-11-14 |