Healthcare Provider Details

I. General information

NPI: 1841275898
Provider Name (Legal Business Name): BELHAVEN FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E WATER ST
BELHAVEN NC
27810-1424
US

IV. Provider business mailing address

161 E WATER ST
BELHAVEN NC
27810-1424
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-3114
  • Fax: 252-943-3281
Mailing address:
  • Phone: 252-943-3114
  • Fax: 252-943-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75148
License Number StateNC

VIII. Authorized Official

Name: EDITH C GUY
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-943-6114