Healthcare Provider Details

I. General information

NPI: 1992363758
Provider Name (Legal Business Name): ALLIANCE MEDICAL MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DONALD ROSS DRIVE
RALEIGH NC
27610-2593
US

IV. Provider business mailing address

101 DONALD ROSS DRIVE
RALEIGH NC
27610-2593
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-3320
  • Fax: 919-250-3322
Mailing address:
  • Phone: 919-250-3320
  • Fax: 919-250-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN K. BURKETT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 919-250-3320