Healthcare Provider Details

I. General information

NPI: 1134670607
Provider Name (Legal Business Name): APPALACHIAN DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NORTHWEST LN
WARRENSVILLE NC
28693-9244
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 336-384-1625
  • Fax:
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-246-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10356
License Number StateNC

VIII. Authorized Official

Name: DARYL BETH LOVETTE
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 828-264-4995