Organization
PROVIDENCE PEDIATRICS
Active
Parent organization
PROVIDENCE PEDIATRICS
Other names
Providence Pediatrics, Atrium Health Levine Children's Providence Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE PEDIATRICS
Authorized official
SCOTT RISSMILLER (ENTERPRISE EVP)
(704) 355-8675
Entity
Organization
Contact information
Practice address
14214 BALLANTYNE LAKE RD, STE 300, CHARLOTTE, NC 28277-3372
(704) 364-3740
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
(704) 631-0002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/04/2006
Last updated
03/09/2023
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