Healthcare Provider Details

I. General information

NPI: 1427163153
Provider Name (Legal Business Name): BEAUFORT REGIONAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 3RD ST
AURORA NC
27806-9088
US

IV. Provider business mailing address

151 3RD ST
AURORA NC
27806-9088
US

V. Phone/Fax

Practice location:
  • Phone: 252-322-4021
  • Fax: 252-322-5088
Mailing address:
  • Phone: 252-322-4021
  • Fax: 252-322-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN S GERARD
Title or Position: PHYSICIAN PRACTICE ADMINISTRATOR
Credential:
Phone: 252-975-4203