Healthcare Provider Details

I. General information

NPI: 1710963335
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES OF MONTGOMERY COUNTY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MAIN ST
TROY NC
27371-2709
US

IV. Provider business mailing address

507 N MAIN ST
TROY NC
27371-2709
US

V. Phone/Fax

Practice location:
  • Phone: 910-576-0042
  • Fax: 910-576-1442
Mailing address:
  • Phone: 910-576-0042
  • Fax: 910-576-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD#9500278
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MONTGOMERY WOODYEAR JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 910-576-0042