Healthcare Provider Details

I. General information

NPI: 1730311648
Provider Name (Legal Business Name): SAMPSON REGIONAL PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BEAMAN ST
CLINTON NC
28328-2602
US

IV. Provider business mailing address

PO BOX 890315
CHARLOTTE NC
28289-0315
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-0046
  • Fax: 910-590-0048
Mailing address:
  • Phone: 910-592-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CANADY
Title or Position: DIRECTOR OF PRACTICE MANAGEMENT
Credential:
Phone: 910-592-8511