Healthcare Provider Details

I. General information

NPI: 1639283567
Provider Name (Legal Business Name): PREMIER PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 WALTER REED RD STE #102
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

1357 WALTER REED RD SUITE 102
FAYETTEVILLE NC
28304-4416
US

V. Phone/Fax

Practice location:
  • Phone: 910-221-3017
  • Fax: 910-221-3018
Mailing address:
  • Phone: 910-221-3017
  • Fax: 910-221-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA S. TAT
Title or Position: PHYSICIAN SECRETARY
Credential: D.O.
Phone: 910-221-3017