Healthcare Provider Details

I. General information

NPI: 1427101948
Provider Name (Legal Business Name): RURAL HALL FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E WALL ST
RURAL HALL NC
27045-9312
US

IV. Provider business mailing address

100 EAST WALL STREET
RURAL HALL NC
27045
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9440
  • Fax: 336-659-9845
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOLLAND
Title or Position: OWNER
Credential: MD
Phone: 336-659-9440