Knox Pediatrics of Brunswick, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

16200 Issued in NC

Legal business name

KNOX PEDIATRICS OF BRUNSWICK, PLLC

Practice address

20 Medical Campus Dr.
Suite 207
Supply, NC 28462-4094

Phone

(910) 755-5066

Fax

(910) 755-5099

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angelina Edralin Knox, MD

Title

Administrator

Phone

(910) 763-3349

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1750458428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MEDICAL CAMPUS DR.",
            "address_2": "SUITE 207",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624092",
            "telephone_number": "910-755-5066",
            "fax_number": "910-755-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MEDICAL CAMPUS DR.",
            "address_2": "SUITE 207",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624094",
            "telephone_number": "910-755-5066",
            "fax_number": "910-755-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOX PEDIATRICS OF BRUNSWICK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "KNOX",
        "authorized_official_first_name": "ANGELINA",
        "authorized_official_middle_name": "EDRALIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-763-3349",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "16200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841218716",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8949897",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903109",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Johnson, LCSWA
• Amy Sue Kelly, PA-C
• Amy Christina Kibler, OTR/L
• Joseph F Kibler, DPM
• Jamie Lauren King Jones, CPT
• James Daniel Kubley, MD
• Thomas Lair, P.T.
• Jonathan Blair Lamphier, MD
• Bernard Leroy Langston III, MD
• Chelsey Mae Lee, LCMHC

• Specialist in Supply, NC
• Providers in Supply, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.