Healthcare Provider Details

I. General information

NPI: 1295209260
Provider Name (Legal Business Name): DUSTIN TURNER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2616 S CHATHAM CT
WINTERVILLE NC
28590-7912
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4100
  • Fax:
Mailing address:
  • Phone: 252-916-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0010-08756
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: