Provider Demographics
NPI:1609243799
Name:FALLS PEDIATRICS
Entity Type:Organization
Organization Name:FALLS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-627-8512
Mailing Address - Street 1:4355 HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-1992
Mailing Address - Country:US
Mailing Address - Phone:828-757-5050
Mailing Address - Fax:
Practice Address - Street 1:4355 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1992
Practice Address - Country:US
Practice Address - Phone:828-757-5050
Practice Address - Fax:828-757-5051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-25
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCALD-25GVJ6364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Single Specialty