Provider Demographics
NPI:1871855379
Name:SNEADS FERRY PEDIATRICS PC
Entity type:Organization
Organization Name:SNEADS FERRY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-327-5437
Mailing Address - Street 1:108 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9415
Mailing Address - Country:US
Mailing Address - Phone:910-327-5437
Mailing Address - Fax:877-505-8468
Practice Address - Street 1:108 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9415
Practice Address - Country:US
Practice Address - Phone:910-327-5437
Practice Address - Fax:877-505-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20000007363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty