Healthcare Provider Details

I. General information

NPI: 1457802928
Provider Name (Legal Business Name): DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 S HORNER BLVD
SANFORD NC
27332-8032
US

IV. Provider business mailing address

2609 S HORNER BLVD
SANFORD NC
27332-8032
US

V. Phone/Fax

Practice location:
  • Phone: 919-718-0414
  • Fax:
Mailing address:
  • Phone: 919-718-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000