DR. ELLIOTT JOHN SALLY (NPI# 1538432018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538432018 |
| Entity Type | Individual |
| Full Name | DR. ELLIOTT JOHN SALLY |
| Credential | DO |
| Practice Address |
1050 Jabara Ave Sjafb, Pediatric Clinic Goldsboro NC 27531-2310 |
| Mailing Address |
5213 S Alston Ave Durham NC 27713-4430 |
| Practice Telephone | 9197221536 |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2020-08-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 0102204044 | VA | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 2020-02658 | NC | Allopathic & Osteopathic Physicians |
| Street Address |
1050 JABARA AVE SJAFB, PEDIATRIC CLINIC |
| City | GOLDSBORO |
| State | NC |
| Zip Code | 27531-2310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821087818 | Todd Alan Cesar | Social Worker | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531-2310 | 2005-10-21 |
| 1184137457 | Jason H Trinh | Pharmacist | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2017-11-09 |
| 1184152910 | David Vincent Peter Espitia | Military Health Care Provider | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2017-05-24 |
| 1972050920 | Brittany Denise Booker | Nurse Practitioner | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2016-09-07 |
| 1699144923 | Matthew Keeney Williams | Physical Therapist | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2015-09-16 |
| 1992144778 | Anthony J Meelan | Family Medicine | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2013-06-14 |
| 1679829634 | Luke Li | Psychiatry & Neurology | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2012-07-27 |
| 1235440439 | Stacy Marie Neagles | Military Health Care Provider | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2010-06-23 |
| 1790931723 | Joshua S Swantek | Pharmacist | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531 | 2008-08-11 |
| 1487810800 | Timothy J Deruyter | Dentist | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531-2310 | 2008-08-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185348 | Adam Golos | Pharmacist | 2803 Medical, N Campus Dr, Goldsboro, NC 27531 | 2019-10-11 |
| 1346747011 | Rachel Eden Leigh Palmer | Military Health Care Provider | 2803 Medical Campus Dr, Seymour Johnson Afb, NC 27531 | 2018-04-10 |
| 1689108508 | Peri Fouss | Pediatrics | 2803 Medical Campus Drive, Goldsboro, NC 27531 | 2017-04-18 |
| 1700256427 | Karen Schaefer | Psychologist | 1050 Jabara Ave., Goldsboro, NC 27531 | 2015-10-07 |
| 1679059737 | Charles Billig | Physician Assistant | 2803 Medical Campus Dr, Goldsboro, NC 27531 | 2018-07-12 |
| 1710413216 | Michael Everett Ridlehoover | Dentist | 2803 Medical Campus Drive, Seymour Johnson Afb, NC 27531 | 2017-05-04 |
| 1831173558 | Thomas Koritz Clinic | Clinic/Center | 1050 Jabara Avenue, Seymour Johnson Afb, NC 27531-2310 | 2005-12-06 |
| 1053316562 | Stephen Brian Irvin | Family Medicine | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2005-06-21 |
| 1952704975 | Andrea Sumner | Physician Assistant | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-10-04 |
| 1114363884 | Nathan Lee Carlson | Military Health Care Provider | 1050 Jabarrah Ave, Goldsboro, NC 27531-2310 | 2013-05-21 |
| Find all providers in zip 27531 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689108508 | Peri Fouss | Pediatrics | 2803 Medical Campus Drive, Goldsboro, NC 27531 | 2017-04-18 |
| 1326115171 | Michelle C Larson | Pediatrics | 2706 Medical Office Plaza, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1871538785 | Joseph W Ponzi | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-06-17 |
| 1063702165 | Bryan Dwayne Stup | Pediatrics | 2706 Medical Office Pl, Goldsboro, NC 27534-9460 | 2011-04-11 |
| 1588954721 | Elisabeth Ann Heiser Stup | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534 | 2011-04-08 |
| 1386820256 | Mdfamily Medical Group | Pediatrics | 1802 E Ash St, Goldsboro, NC 27530-4045 | 2008-01-10 |
| 1679640429 | Carey Ziemer | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1588731335 | Christopher P Griffin | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1427125269 | Goldsboro Pediatrics Pa | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| 1932276797 | Erika S Boyd | Pediatrics | 2706 Medical Office Place, Goldsboro, NC 27534-9460 | 2006-11-29 |
| Find all providers in GOLDSBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.