Healthcare Provider Details

I. General information

NPI: 1033196837
Provider Name (Legal Business Name): FAMILY MEDICAL CARE OF ROWAN-SPENCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 5TH ST
SPENCER NC
28159-2125
US

IV. Provider business mailing address

300 N SALISBURY AVE
SPENCER NC
28159-2514
US

V. Phone/Fax

Practice location:
  • Phone: 704-639-9124
  • Fax: 704-639-9717
Mailing address:
  • Phone: 704-633-7070
  • Fax: 704-633-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LLYOD EMERY NICKERSON
Title or Position: OWNER MEDICAL DOCTOR
Credential: MD
Phone: 704-633-7070