Healthcare Provider Details

I. General information

NPI: 1063890176
Provider Name (Legal Business Name): DLP MARIA PARHAM PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 252-436-1566
  • Fax: 252-436-1568
Mailing address:
  • Phone: 252-436-1680
  • Fax: 252-436-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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