Healthcare Provider Details

I. General information

NPI: 1841248622
Provider Name (Legal Business Name): COUNTY OF BRUNSWICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/12/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTHOUSE DR. NE BLG A
BOLIVIA NC
28422-0009
US

IV. Provider business mailing address

PO BOX 9
BOLIVIA NC
28422-0009
US

V. Phone/Fax

Practice location:
  • Phone: 910-253-2250
  • Fax: 910-253-2370
Mailing address:
  • Phone: 910-253-2284
  • Fax: 102-532-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D0245906
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number04210
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. BARBARA RANDOLPH JACKSON
Title or Position: MANAGEMENT SUPPORT DIRECTOR
Credential:
Phone: 910-253-2284