Healthcare Provider Details

I. General information

NPI: 1104943844
Provider Name (Legal Business Name): CRO PC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 A HENDERSON DR EXT
JACKSONVILLE NC
28546-5250
US

IV. Provider business mailing address

3280 A HENDERSON DR EXT
JACKSONVILLE NC
28546-5250
US

V. Phone/Fax

Practice location:
  • Phone: 910-937-7200
  • Fax: 910-937-7061
Mailing address:
  • Phone: 910-937-7200
  • Fax: 910-937-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. CHRISSY RICE
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-937-7200