Organization
WILKES PEDIATRIC CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE T JOHNSON (PRACTICE MANAGER)
(336) 903-0096
Entity
Organization
Contact information
Practice address
1925 W PARK DR, NORTH WILKESBORO, NC 28659-3564
(336) 903-0147
(336) 903-1687
Mailing address
1925 W PARK DR, NORTH WILKESBORO, NC 28659-3564
(336) 903-0147
(336) 903-1687
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89013NN
—
NC
Enumeration date
08/22/2006
Last updated
08/22/2020
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