Healthcare Provider Details

I. General information

NPI: 1164672515
Provider Name (Legal Business Name): ANGEL FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST LIVERMORE DRIVE
PEMBROKE NC
28372
US

IV. Provider business mailing address

201 LIVERMORE DR
PEMBROKE NC
28372-7322
US

V. Phone/Fax

Practice location:
  • Phone: 910-272-6422
  • Fax: 910-521-4237
Mailing address:
  • Phone: 910-272-6422
  • Fax: 910-521-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number102637
License Number StateNC

VIII. Authorized Official

Name: MS. DAWN TRACY LANGLEY
Title or Position: PRESIDENT/CEO
Credential: PA-C
Phone: 910-272-6422