Provider Demographics
NPI:1982833976
Name:ABC PEDIATRICS OF GREENSBORO, P.A.
Entity Type:Organization
Organization Name:ABC PEDIATRICS OF GREENSBORO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:SHANI
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-235-3060
Mailing Address - Street 1:1002 N CHURCH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1440
Mailing Address - Country:US
Mailing Address - Phone:336-235-3060
Mailing Address - Fax:336-235-3079
Practice Address - Street 1:1002 N CHURCH ST STE 1
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1440
Practice Address - Country:US
Practice Address - Phone:336-235-3060
Practice Address - Fax:336-235-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty