Healthcare Provider Details

I. General information

NPI: 1164503702
Provider Name (Legal Business Name): DUPLIN MEDICAL ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S SYCAMORE ST
ROSE HILL NC
28458-4700
US

IV. Provider business mailing address

600 SOUTH SYCAMORE STREET PO BOX 639
ROSE HILL NC
28458
US

V. Phone/Fax

Practice location:
  • Phone: 910-289-3027
  • Fax: 910-289-2894
Mailing address:
  • Phone: 910-289-3027
  • Fax: 910-289-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101600
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103247
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. KRISTINE M LEWIS, PA-C
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 910-289-3027