Healthcare Provider Details

I. General information

NPI: 1205293842
Provider Name (Legal Business Name): DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 FAIRGROVE CHURCH RD SE
CONOVER NC
28613-9090
US

IV. Provider business mailing address

1105 FAIRGROVE CHURCH RD SE
CONOVER NC
28613-9090
US

V. Phone/Fax

Practice location:
  • Phone: 615-920-7000
  • Fax:
Mailing address:
  • Phone: 615-920-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000