Healthcare Provider Details

I. General information

NPI: 1972719698
Provider Name (Legal Business Name): CARRBORO FAMILY MEDICINE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/02/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 JONES FERRY RD STE 102
CARRBORO NC
27510-6113
US

IV. Provider business mailing address

610 JONES FERRY RD STE 102
CARRBORO NC
27510-6113
US

V. Phone/Fax

Practice location:
  • Phone: 919-929-1747
  • Fax: 919-933-5168
Mailing address:
  • Phone: 919-929-1747
  • Fax: 919-933-5168

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: RUTH ANN BULLOCK
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 919-929-1747