Healthcare Provider Details

I. General information

NPI: 1396770392
Provider Name (Legal Business Name): HOWERTON FAMILY MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W NC HIGHWAY 24
ROSEBORO NC
28382-8684
US

IV. Provider business mailing address

304 W NC HIGHWAY 24
ROSEBORO NC
28382-8684
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-5848
  • Fax: 910-525-3838
Mailing address:
  • Phone: 910-525-5848
  • Fax: 910-525-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005-00915
License Number StateNC

VIII. Authorized Official

Name: DR. SHAWN MICHAEL HOWERTON
Title or Position: PRESIDENT
Credential: MD
Phone: 910-525-5848