Healthcare Provider Details

I. General information

NPI: 1033115407
Provider Name (Legal Business Name): PHYSICIANS EAST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 N MAIN ST
FARMVILLE NC
27828-1464
US

IV. Provider business mailing address

3681 N MAIN ST
FARMVILLE NC
27828-1464
US

V. Phone/Fax

Practice location:
  • Phone: 252-753-7141
  • Fax: 252-753-5834
Mailing address:
  • Phone: 252-753-7141
  • Fax: 252-753-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HALE HAMPTON STEPHENSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 252-758-4181