Healthcare Provider Details

I. General information

NPI: 1518943257
Provider Name (Legal Business Name): TARHEEL INTERNAL MEDICINE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST BUILDING 4
ELIZABETH CITY NC
27909-3365
US

IV. Provider business mailing address

1134 N ROAD STREET BUILDING 4
ELIZABETH CITY NC
27909-3361
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-4117
  • Fax:
Mailing address:
  • Phone: 252-338-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number16929
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER LYNN HEWITT
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-338-4117