Healthcare Provider Details

I. General information

NPI: 1730466475
Provider Name (Legal Business Name): DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 RUIN CREEK RD SUITE 006
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: 252-436-1051
  • Fax: 252-430-8980
Mailing address:
  • Phone: 252-436-1051
  • Fax: 252-430-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY TEAGUE
Title or Position: AVP, SECRETARY
Credential:
Phone: 615-920-7000