Healthcare Provider Details

I. General information

NPI: 1710881446
Provider Name (Legal Business Name): BETHANY FAITH PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

IV. Provider business mailing address

600 ABBID ST
LEXINGTON NC
27292-9185
US

V. Phone/Fax

Practice location:
  • Phone: 336-474-8153
  • Fax:
Mailing address:
  • Phone: 336-239-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16996
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-16996
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: