Healthcare Provider Details

I. General information

NPI: 1235295338
Provider Name (Legal Business Name): HALIFAX MEDICAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 JEFFREYS RD #144
ROCKY MOUNT NC
27804-1820
US

IV. Provider business mailing address

1444 JEFFREYS RD #144
ROCKY MOUNT NC
27804-1820
US

V. Phone/Fax

Practice location:
  • Phone: 252-977-0279
  • Fax:
Mailing address:
  • Phone: 252-977-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HUME FAULKNER
Title or Position: PRESIDENT
Credential: PA-C, MPH
Phone: 252-977-0279