Healthcare Provider Details

I. General information

NPI: 1831173558
Provider Name (Legal Business Name): SEYMOUR JOHNSON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB NC
27531-2310
US

IV. Provider business mailing address

2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB NC
27531
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-8257
  • Fax:
Mailing address:
  • Phone: 919-722-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: WILLIAM CONDON
Title or Position: DHA UBO
Credential:
Phone: 240-401-3643