Healthcare Provider Details

I. General information

NPI: 1558114090
Provider Name (Legal Business Name): GODS PROMISES OF ROCKY MOUNT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SW MAIN ST
ROCKY MOUNT NC
27804-5715
US

IV. Provider business mailing address

154 SW MAIN ST
ROCKY MOUNT NC
27804-5715
US

V. Phone/Fax

Practice location:
  • Phone: 252-937-3022
  • Fax: 252-937-3021
Mailing address:
  • Phone: 252-937-3022
  • Fax: 252-937-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONIQUE BROWN
Title or Position: CMO
Credential: MD
Phone: 252-450-0753