Healthcare Provider Details

I. General information

NPI: 1538147038
Provider Name (Legal Business Name): EAST CAROLINA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ACADEMY ST S
AHOSKIE NC
27910-3264
US

IV. Provider business mailing address

700 ACADEMY ST S
AHOSKIE NC
27910-3264
US

V. Phone/Fax

Practice location:
  • Phone: 252-209-3614
  • Fax:
Mailing address:
  • Phone: 252-209-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0001
License Number StateNC

VIII. Authorized Official

Name: MR. JON GRAHAM
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 252-209-3610