Organization
SHALOM PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RITA OBIAGELI NNAEMEKAOKOYEH MD (MEDICAL DIRECTOR)
(336) 574-8355
Entity
Organization
Contact information
Practice address
2806 RANDLEMAN RD, SUITE M, GREENSBORO, NC 27406-5265
(336) 574-8355
(336) 273-9192
Mailing address
2806 RANDLEMAN RD, SUITE M, GREENSBORO, NC 27406-5265
(336) 574-8355
(336) 273-9192
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2005-01548
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4188
—
NC
Enumeration date
08/17/2011
Last updated
08/17/2011
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