Healthcare Provider Details

I. General information

NPI: 1316033590
Provider Name (Legal Business Name): FAMILY CARE CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114C MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

IV. Provider business mailing address

114C MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-9688
  • Fax: 910-353-7498
Mailing address:
  • Phone: 910-353-9688
  • Fax: 910-353-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID F BULLARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 910-353-3389