Provider Demographics
NPI:1265584767
Name:MARTIN'S PEDIATRICS AND FAMILY CARE
Entity type:Organization
Organization Name:MARTIN'S PEDIATRICS AND FAMILY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:910-938-2220
Mailing Address - Street 1:3221 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5251
Mailing Address - Country:US
Mailing Address - Phone:910-938-2220
Mailing Address - Fax:910-938-2223
Practice Address - Street 1:3221 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5251
Practice Address - Country:US
Practice Address - Phone:910-938-2220
Practice Address - Fax:910-938-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty