Healthcare Provider Details

I. General information

NPI: 1134560402
Provider Name (Legal Business Name): DLP PERSON PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 RIDGE RD
ROXBORO NC
27573-4627
US

IV. Provider business mailing address

PO BOX 561
ROXBORO NC
27573-0561
US

V. Phone/Fax

Practice location:
  • Phone: 336-503-5703
  • Fax: 336-322-1819
Mailing address:
  • Phone: 336-503-4810
  • Fax: 336-599-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000