Healthcare Provider Details

I. General information

NPI: 1194700799
Provider Name (Legal Business Name): EDWIN P LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S CENTRAL AVE
PINK HILL NC
28572
US

IV. Provider business mailing address

701 DOCTORS DRIVE SUITE N
KINSTON NC
28501
US

V. Phone/Fax

Practice location:
  • Phone: 252-568-4111
  • Fax: 252-568-6396
Mailing address:
  • Phone: 252-559-2200
  • Fax: 252-522-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27234
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: