Healthcare Provider Details

I. General information

NPI: 1154231330
Provider Name (Legal Business Name): TARHEEL STATE EMERGENCY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

400 GALLERIA PKWY SE STE 960
ATLANTA GA
30339-5980
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLYSON WIRTZ
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 337-581-6920