Healthcare Provider Details

I. General information

NPI: 1326217399
Provider Name (Legal Business Name): MED MART MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 GB ALFORD HWY
HOLLY SPRINGS NC
27540-7661
US

IV. Provider business mailing address

100 S 10TH ST
LILLINGTON NC
27546-6690
US

V. Phone/Fax

Practice location:
  • Phone: 919-552-1520
  • Fax: 919-552-8792
Mailing address:
  • Phone: 910-893-4111
  • Fax: 910-893-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9500701
License Number StateNC

VIII. Authorized Official

Name: DR. RODOLFO C REYES
Title or Position: OWNER
Credential: MD
Phone: 910-893-4111