Provider Demographics
NPI:1891094553
Name:THOMASVILLE/ARCHDALE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:THOMASVILLE/ARCHDALE PEDIATRICS PLLC
Other - Org Name:ANCILLARY
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-475-4596
Mailing Address - Street 1:200 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6275
Mailing Address - Country:US
Mailing Address - Phone:336-475-2348
Mailing Address - Fax:336-475-2100
Practice Address - Street 1:200 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6275
Practice Address - Country:US
Practice Address - Phone:336-475-2348
Practice Address - Fax:336-475-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty