Organization
CAROLINA PEDIATRIC CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLIVIA B MIJUMBI MD (MEDICAL DIRECTOR)
(704) 864-0303
Entity
Organization
Contact information
Practice address
239 WILMOT DR STE A, GASTONIA, NC 28054-4048
(704) 864-0303
(704) 864-6070
Mailing address
PO BOX 550818, GASTONIA, NC 28055-0818
(704) 864-0303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-01098
UNITEDHEALTHCARE
NC
01
—
1322Y
BCBS
NC
01
—
2900124
AETNA
NC
05
—
891322Y
—
NC
01
—
9259849
PHCS
MA
01
—
9554744001
CIGNA
NC
01
—
A8708
MEDCOST
NC
Enumeration date
07/25/2013
Last updated
02/01/2023
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