Healthcare Provider Details

I. General information

NPI: 1639934359
Provider Name (Legal Business Name): DON CORNEIUS PIGFORD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 VILLAGE PARK DR
HOOKERTON NC
28538-9772
US

IV. Provider business mailing address

113 VILLAGE PARK DR
HOOKERTON NC
28538-9772
US

V. Phone/Fax

Practice location:
  • Phone: 252-286-8937
  • Fax:
Mailing address:
  • Phone: 252-286-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: