Healthcare Provider Details

I. General information

NPI: 1104805068
Provider Name (Legal Business Name): FRANKLIN D EGOLF JR. PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W BROAD ST
ELIZABETHTOWN NC
28337
US

IV. Provider business mailing address

454 OLD TOM MORRIS RD
GARLAND NC
28441
US

V. Phone/Fax

Practice location:
  • Phone: 910-862-4151
  • Fax: 910-862-3470
Mailing address:
  • Phone: 910-529-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: