Healthcare Provider Details

I. General information

NPI: 1912210865
Provider Name (Legal Business Name): WILMINGTON HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRABHAM AVENUE
JACKSONVILLE NC
28546-5003
US

IV. Provider business mailing address

PO BOX 600002
RALEIGH NC
27675-6002
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-1515
  • Fax: 910-347-7982
Mailing address:
  • Phone: 910-341-3300
  • Fax: 910-347-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73991
License Number StateNC

VIII. Authorized Official

Name: CHASITY CHACE
Title or Position: DIRECTOR OF BUSINESS OFFICE
Credential:
Phone: 910-341-3384