Healthcare Provider Details

I. General information

NPI: 1295745099
Provider Name (Legal Business Name): JOHNSTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N ENGLEWOOD DR
KENLY NC
27542-9290
US

IV. Provider business mailing address

400 N ENGLEWOOD DR
KENLY NC
27542-9290
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-4149
  • Fax: 919-284-6008
Mailing address:
  • Phone: 919-284-4149
  • Fax: 919-284-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number9900728
License Number StateNC

VIII. Authorized Official

Name: DR. MICHAEL VINCENT WOODBRIDGE IV
Title or Position: DOCTOR
Credential: MD
Phone: 919-284-4149