Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2017-00236 | NC |
NPI | 1003089764 |
---|---|
Provider Name | Amy Little |
First Address | Charlotte, NC 28219-9305 |
Second Address | Gastonia, NC 28054-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 27/09/2021 |