Healthcare Provider Details

I. General information

NPI: 1568489110
Provider Name (Legal Business Name): GEORGIA A DRUMHELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGIA A HENNESSY MD

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 S CROATAN HWY SUITE 100
NAGS HEAD NC
27959
US

IV. Provider business mailing address

1141 N ROAD ST STE M
ELIZABETH CITY NC
27909-3354
US

V. Phone/Fax

Practice location:
  • Phone: 252-449-7373
  • Fax: 252-449-7371
Mailing address:
  • Phone: 252-449-7373
  • Fax: 252-449-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200500382
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: