Provider Demographics
NPI:1699735951
Name:GROWING UP PEDIATRICS
Entity type:Organization
Organization Name:GROWING UP PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-895-9060
Mailing Address - Street 1:8311 MAGNOLIA ESTATES DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8070
Mailing Address - Country:US
Mailing Address - Phone:704-895-9060
Mailing Address - Fax:704-895-6494
Practice Address - Street 1:8311 MAGNOLIA ESTATES DR
Practice Address - Street 2:SUITE E
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8070
Practice Address - Country:US
Practice Address - Phone:704-895-9060
Practice Address - Fax:704-895-6494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011G6Medicaid