Organization
SUBURBAN PEDIATRIC CLINIC, INC.
Active
Parent organization
SUBURBAN PEDIATRIC CLINIC, INC.
Other names
Suburban Pediatric Clinic - Davidson
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUBURBAN PEDIATRIC CLINIC, INC.
Authorized official
THOMAS F LAYMON (SR. VICE PRESIDENT)
(704) 403-2276
Entity
Organization
Contact information
Practice address
2101 SHILOH CHURCH RD, SUITE 101, DAVIDSON, NC 28036-7603
(704) 439-3700
(704) 439-3729
Mailing address
2101 SHILOH CHURCH RD, SUITE 101, DAVIDSON, NC 28036-7603
(704) 439-3700
(704) 439-3729
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01491
BCBS GROUP ID
NC
05
—
5903375
—
NC
05
—
5906983
—
NC
01
—
896408
MAMSI
NC
Enumeration date
01/19/2007
Last updated
01/26/2016
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