Organization
247 KID DOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY BAIN SHANNON (PRESIDENT)
(844) 303-8006
Entity
Organization
Contact information
Practice address
3304 STONESTHROW DR, NEWTON, NC 28658-8883
(844) 303-8006
Mailing address
3304 STONESTHROW DR, NEWTON, NC 28658-8883
(844) 303-8006
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2016-02169
NC
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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