Provider Demographics
NPI:1821000779
Name:PIEDMONT PEDIATRIC CENTER
Entity Type:Organization
Organization Name:PIEDMONT PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-736-0028
Mailing Address - Street 1:1446 E GASTON ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4416
Mailing Address - Country:US
Mailing Address - Phone:704-736-0028
Mailing Address - Fax:704-736-0096
Practice Address - Street 1:1446 E GASTON ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4416
Practice Address - Country:US
Practice Address - Phone:704-736-0028
Practice Address - Fax:704-736-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty