Healthcare Provider Details

I. General information

NPI: 1619334950
Provider Name (Legal Business Name): DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CENTER ST STE. 203
HICKORY NC
28601-5057
US

IV. Provider business mailing address

415 N CENTER ST STE. 203
HICKORY NC
28601-5057
US

V. Phone/Fax

Practice location:
  • Phone: 828-323-8281
  • Fax: 828-323-8322
Mailing address:
  • Phone: 828-323-8281
  • Fax: 828-323-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000