| Organization Name: | SNEADS FERRY PEDIATRICS PC |
| NPI Number: | 1871855379 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACK WILCOX (CEO) |
| Mailing Address: | 108 Lakeside Dr Sneads Ferry |
| State: | NC US |
| Postal Code: | 284609415 |
| Phone Number: | 9103275437 |
| Fax Number: | 8775058468 |
| NPI Enumeration Date: | 06/11/2012 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 20000007 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |