Healthcare Provider Details

I. General information

NPI: 1881553774
Provider Name (Legal Business Name): JOSEPH JORDAN MCNULTY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CARTHAGE ST
SANFORD NC
27330-4104
US

IV. Provider business mailing address

211 GRIGSBY AVE
HOLLY SPRINGS NC
27540-8947
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-6518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-17053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: