Healthcare Provider Details

I. General information

NPI: 1841455755
Provider Name (Legal Business Name): JOHNSTON PRIMARY CARE PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N BRIGHTLEAF BLVD SUITE 1702
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

PO BOX 1376
SMITHFIELD NC
27577-1376
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-7442
  • Fax:
Mailing address:
  • Phone: 919-938-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN P SAWYER
Title or Position: VP & CFO
Credential:
Phone: 919-934-8171