Healthcare Provider Details

I. General information

NPI: 1215273628
Provider Name (Legal Business Name): DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 RUIN CREEK RD SUITE 001
HENDERSON NC
27536-2880
US

IV. Provider business mailing address

120 CHARLES ROLLINS RD SUITE 206
HENDERSON NC
27536-2882
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-7102
  • Fax: 252-438-7102
Mailing address:
  • Phone: 252-436-1680
  • Fax: 252-492-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIOLET M HARRISON
Title or Position: BILLING MANAGER
Credential:
Phone: 252-436-1680