Healthcare Provider Details

I. General information

NPI: 1558750893
Provider Name (Legal Business Name): DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHARLES ROLLINS ROAD SUITE 206
HENDERSON NC
27536
US

IV. Provider business mailing address

511 RUIN CREEK ROAD SUITE 106
HENDERSON NC
27536-5912
US

V. Phone/Fax

Practice location:
  • Phone: 252-436-1680
  • Fax: 252-436-6480
Mailing address:
  • Phone: 252-436-6571
  • Fax: 252-438-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7362