Healthcare Provider Details

I. General information

NPI: 1538517917
Provider Name (Legal Business Name): DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TATE BLVD SE SUITE 186
HICKORY NC
28602-4042
US

IV. Provider business mailing address

915 TATE BLVD SE SUITE 186
HICKORY NC
28602-4042
US

V. Phone/Fax

Practice location:
  • Phone: 828-324-0359
  • Fax: 828-324-0358
Mailing address:
  • Phone: 828-324-0359
  • Fax: 828-324-0358

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: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7212