Healthcare Provider Details

I. General information

NPI: 1851787105
Provider Name (Legal Business Name): MARTA ELISABETH DAHLE BRINGHURST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N JOHNSON ST
COATS NC
27521-8407
US

IV. Provider business mailing address

25 N JOHNSON ST
COATS NC
27521-8407
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-6423
  • Fax:
Mailing address:
  • Phone: 910-897-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-01972
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2019-01972
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: