Provider Demographics
NPI:1932353208
Name:CHILDREN'S HEALTH OF CAROLINA, PA
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH OF CAROLINA, PA
Other - Org Name:CHILDREN'S HEALTH CUMBERLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-8060
Mailing Address - Street 1:1738 OWEN DR STE 107
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3419
Mailing Address - Country:US
Mailing Address - Phone:910-307-7330
Mailing Address - Fax:910-307-7334
Practice Address - Street 1:1738 OWEN DR STE 107
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3419
Practice Address - Country:US
Practice Address - Phone:910-307-7330
Practice Address - Fax:910-307-7334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HEALTH OF CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty