Healthcare Provider Details

I. General information

NPI: 1831738178
Provider Name (Legal Business Name): MS. CHARMAY DENEEN FRYAR-ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 DUNN RD STE 101
EASTOVER NC
28312-9417
US

IV. Provider business mailing address

3947 DUNN RD
EASTOVER NC
28312-8533
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-6277
  • Fax: 910-483-6369
Mailing address:
  • Phone: 910-483-6277
  • Fax: 910-483-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberFRYA-E02HVF
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5012690
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: