Healthcare Provider Details

I. General information

NPI: 1528058963
Provider Name (Legal Business Name): NORTH CAROLINA PHYSICIAN NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DOCTORS CIR SUITE 5
SUPPLY NC
28462-4088
US

IV. Provider business mailing address

14 DOCTORS CIR SUITE 5
SUPPLY NC
28462-4088
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-9166
  • Fax: 910-754-2972
Mailing address:
  • Phone: 910-754-9166
  • Fax: 910-754-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK BIRMINGHAM
Title or Position: DIRECTOR
Credential:
Phone: 615-373-7625