Organization
FAYETTEVILLE CHILDREN'S CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM HUSKE KELLY M.D. (PRESIDENT)
(910) 484-3121
Entity
Organization
Contact information
Practice address
1606 MORGANTON RD, FAYETTEVILLE, NC 28305-4738
(910) 484-3121
(910) 484-9027
Mailing address
PO BOX 53127, FAYETTEVILLE, NC 28305-3127
(910) 484-3121
(910) 484-9027
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
39028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0235G
BLUE CROSS BLUE SHIELD
NC
05
—
790235G
—
NC
Enumeration date
09/27/2006
Last updated
07/10/2013
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