Healthcare Provider Details

I. General information

NPI: 1891768958
Provider Name (Legal Business Name): ALLEGHANY FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 DOCTORS ST
SPARTA NC
28675
US

IV. Provider business mailing address

214 DOCTORS ST
SPARTA NC
28675
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5606
  • Fax: 336-372-6211
Mailing address:
  • Phone: 336-372-5606
  • Fax: 336-372-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40433
License Number StateNC

VIII. Authorized Official

Name: MR. JACK RICHARD CAHN
Title or Position: MD AND PRESIDENT
Credential: MD
Phone: 336-372-5606