Organization
KINGS MOUNTAIN PEDIATRIC CLINIC
Active
Other names
Kings Mountain Pediatrics, PA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN WADE STALLINGS M.D. (DOCTOR)
(704) 739-2521
Entity
Organization
Contact information
Practice address
108 EDGEMONT DR, KINGS MOUNTAIN, NC 28086-2702
(704) 739-2521
(704) 739-4314
Mailing address
108 EDGEMONT DR, KINGS MOUNTAIN, NC 28086-2702
(704) 739-2521
(704) 739-4314
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
19089
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79192
BLUE CROSS BLUE SHIELD
NC
05
—
8979192
—
NC
Enumeration date
01/06/2006
Last updated
04/26/2017
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