Healthcare Provider Details

I. General information

NPI: 1093723538
Provider Name (Legal Business Name): VALLEY RADIOLOGY, P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 VILLAGE DR STE 201
FAYETTEVILLE NC
28304-3979
US

IV. Provider business mailing address

3186 VILLAGE DR STE 201
FAYETTEVILLE NC
28304-3979
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5700
  • Fax: 910-486-5950
Mailing address:
  • Phone: 910-486-5700
  • Fax: 910-486-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY T BROWN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 910-486-5700