Healthcare Provider Details

I. General information

NPI: 1497792022
Provider Name (Legal Business Name): EASTERN CAROLINA FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COMMERCE STREET
POWELLSVILLE NC
27967
US

IV. Provider business mailing address

1134 N ROAD ST BLDG.9
ELIZABETH CITY NC
27909-3365
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-6484
  • Fax: 252-332-1660
Mailing address:
  • Phone: 252-338-9451
  • Fax: 252-338-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY L WHITE
Title or Position: PRESIDENT
Credential: MD
Phone: 252-338-9451