# JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA

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

## Provider details

- **NPI number:** 1164519070
- **Authorized official:** ISHWAR HAKUMAL GOPICHAND MD (CMO)
- **Authorized official phone:** (919) 589-1240

## Contact information

- **Practice address:** 118 MEMORIAL DR, JACKSONVILLE, NC 28546-6328
- **Practice address phone:** (910) 353-0581
- **Practice address fax:** (910) 353-1351
- **Mailing address:** PO BOX 986513, DEPARTMENT 100, BOSTON, MA 02298-6513
- **Mailing address phone:** (910) 219-8326
- **Mailing address fax:** (910) 939-4269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KA0200X | Allergy Physician | — | NULL | — |
| 207KA0200X | Allergy Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | — |
| 2080P0008X | Pediatric Neurodevelopmental Disabilities Physician | — | NULL | — |
| 2080P0008X | Pediatric Neurodevelopmental Disabilities Physician | — | — | — |
| 2080P0202X | Pediatric Cardiology Physician | — | NULL | — |
| 2080P0202X | Pediatric Cardiology Physician | — | — | — |

## Other

- **Enumeration date:** 10/10/2006
- **Last updated:** 01/19/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164519070 | — | NC |