Healthcare Provider Details

I. General information

NPI: 1144316324
Provider Name (Legal Business Name): FHPG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 US HIGHWAY 220 ALT S
BISCOE NC
27209-9564
US

IV. Provider business mailing address

1122 US HIGHWAY 220 ALT S
BISCOE NC
27209-9564
US

V. Phone/Fax

Practice location:
  • Phone: 910-428-9392
  • Fax: 910-428-1861
Mailing address:
  • Phone: 910-428-9392
  • Fax: 910-428-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICKEY FOSTER
Title or Position: CEO
Credential:
Phone: 910-715-4473