Healthcare Provider Details

I. General information

NPI: 1437112968
Provider Name (Legal Business Name): FLOYD DEEN, JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MORVEN RD
WADESBORO NC
28170-2743
US

IV. Provider business mailing address

402 MORVEN RD
WADESBORO NC
28170-2743
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-5164
  • Fax: 704-695-1184
Mailing address:
  • Phone: 704-694-5164
  • Fax: 704-695-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number39033
License Number StateNC

VIII. Authorized Official

Name: MS. DEBBIE CARPENTER
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 704-694-5164