Healthcare Provider Details

I. General information

NPI: 1386990992
Provider Name (Legal Business Name): DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 252-436-6240
  • Fax: 252-492-5707
Mailing address:
  • Phone: 252-436-6240
  • Fax: 252-492-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY D VAUGHN
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-565-1508