Healthcare Provider Details

I. General information

NPI: 1689039166
Provider Name (Legal Business Name): DLP FRYE REGIONAL PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TATE BLVD SE
HICKORY NC
28602-1450
US

IV. Provider business mailing address

2850 TATE BLVD SE
HICKORY NC
28602-1450
US

V. Phone/Fax

Practice location:
  • Phone: 615-920-7000
  • Fax:
Mailing address:
  • Phone: 615-920-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

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