Provider Demographics
NPI:1194496745
Name:NORTH AUGUSTA PEDIATRICS LLC
Entity type:Organization
Organization Name:NORTH AUGUSTA PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-510-0007
Mailing Address - Street 1:140 ALLEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9782
Mailing Address - Country:US
Mailing Address - Phone:803-510-0007
Mailing Address - Fax:803-510-0144
Practice Address - Street 1:140 ALLEN CT
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9782
Practice Address - Country:US
Practice Address - Phone:803-510-0007
Practice Address - Fax:803-510-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health