Healthcare Provider Details

I. General information

NPI: 1891831038
Provider Name (Legal Business Name): JOHNNY LEE FARROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 US HIGHWAY 64
MANTEO NC
27954-9241
US

IV. Provider business mailing address

715 US HIGHWAY 64
MANTEO NC
27954-9241
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-2500
  • Fax: 252-473-1222
Mailing address:
  • Phone: 252-473-2500
  • Fax: 252-473-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9401185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: