Healthcare Provider Details

I. General information

NPI: 1790133171
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: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N CENTER ST
HICKORY NC
28601-5033
US

IV. Provider business mailing address

420 N CENTER ST
HICKORY NC
28601-5033
US

V. Phone/Fax

Practice location:
  • Phone: 828-323-1100
  • Fax: 828-324-9189
Mailing address:
  • Phone: 828-323-1100
  • Fax: 828-324-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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