# 247 KID DOC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073063459
- **Authorized official:** MR. TIMOTHY BAIN SHANNON (PRESIDENT)
- **Authorized official phone:** (844) 303-8006

## Contact information

- **Practice address:** 3304 STONESTHROW DR, NEWTON, NC 28658-8883
- **Practice address phone:** (844) 303-8006
- **Mailing address:** 3304 STONESTHROW DR, NEWTON, NC 28658-8883
- **Mailing address phone:** (844) 303-8006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 2016-02169 | NC | Yes |

## Other

- **Enumeration date:** 10/10/2016
- **Last updated:** 10/10/2016