MEDICARE: UCFA PHYSICIANS NETWORK GROUP OF NORTH CAROLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1154098127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCFA PHYSICIANS NETWORK GROUP OF NORTH CAROLINA

Provider Business Mailing Address
First Line	:	8930 CROSS PARK DR STE 3
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4713
Country	:	US
Telephone Number	:	423-271-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 CENTERVIEW DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3363
Country	:	US
Telephone Number	:	423-271-9911
Fax Number	:

Authorized Official
Title or Position	:	ACTING CHIEF PRMG
Name	:	THEO STEPHENS
Credential	:
Telephone Number	:	423-271-9911

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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