Healthcare Provider Details

I. General information

NPI: 1225524598
Provider Name (Legal Business Name): GEM CAPITAL PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
LOUISBURG NC
27549-2256
US

IV. Provider business mailing address

PO BOX 23801
BELFAST ME
04915-4489
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-4143
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM H LARSEN
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 770-874-5400