Healthcare Provider Details

I. General information

NPI: 1548290265
Provider Name (Legal Business Name): FHPG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 7 LAKES DR STE C
WEST END NC
27376-9081
US

IV. Provider business mailing address

1035 7 LAKES DR STE C
WEST END NC
27376-9081
US

V. Phone/Fax

Practice location:
  • Phone: 910-673-0045
  • Fax: 910-673-5705
Mailing address:
  • Phone: 910-673-0045
  • Fax: 910-673-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103285
License Number StateNC

VIII. Authorized Official

Name: MICKEY FOSTER
Title or Position: CEO
Credential:
Phone: 910-715-4473