Organization
SOUTHFORK PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA K BROWN (PRACTICE MANAGER)
(828) 726-1379
Entity
Organization
Contact information
Practice address
1733 CONNELLY SPRINGS RD, LENOIR, NC 28645-7827
(828) 726-8885
(828) 726-8883
Mailing address
1733 CONNELLY SPRINGS RD, LENOIR, NC 28645-7827
(828) 726-8885
(828) 726-8883
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
9701479
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1141R
BCBS OF NC
NC
01
—
1467112
CIGNA
NC
01
—
2359139
UNITED HEALTH CARE
NC
01
—
891141R
CAROLINA ACCESS
NC
05
—
891141R
—
NC
01
—
B0324
MEDCOST
NC
Enumeration date
06/21/2005
Last updated
04/20/2008
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