Individual ProviderSean ChildressPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3200 Northline Ave, Suite 200, Greensboro, NC 27408(336) 545-5000PECOS EnrollmentBased on the most recent information from CMS, provider Sean Childress is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:21 AM.Profile DetailsProvider ID1639753890Provider TypeIndividualFull NameChildress, SeanGenderMaleSole ProprietorNoEnumeration Date5/12/2021Last Updated1/20/2025Contact InformationPractice LocationPractice Address3200 Northline Ave, Suite 200, Greensboro, NC 27408Phone(336) 545-5000FaxUnlisted FaxMailing LocationMailing Address3000 New Bern Ave, Raleigh, NC 27610-1231PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1639753890DescriptionMedicaidIssuerUnlistedNorth Carolina