Provider Demographics
NPI:1487619185
Name:STATESVILLE CHILDRENS CLINIC PA
Entity type:Organization
Organization Name:STATESVILLE CHILDRENS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-872-9595
Mailing Address - Street 1:925 A THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-872-9595
Mailing Address - Fax:704-872-5851
Practice Address - Street 1:925 A THOMAS ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-872-9595
Practice Address - Fax:704-872-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910031Medicaid
NC8902744Medicaid
C82546Medicare UPIN