Provider Demographics
NPI:1245300714
Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:FARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-667-6710
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-1730
Mailing Address - Country:US
Mailing Address - Phone:843-395-6112
Mailing Address - Fax:843-395-9062
Practice Address - Street 1:105 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-6044
Practice Address - Country:US
Practice Address - Phone:843-395-6112
Practice Address - Fax:843-395-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9606Medicaid