Healthcare Provider Details

I. General information

NPI: 1689851834
Provider Name (Legal Business Name): AFFINITY HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 WRIGHTSVILLE AVE 5421
WILMINGTON NC
28403-6513
US

IV. Provider business mailing address

5421 WRIGHTSVILLE AVE 5421
WILMINGTON NC
28403-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3330
  • Fax: 910-792-1004
Mailing address:
  • Phone: 910-762-6524
  • Fax: 910-792-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005634
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20010111001
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number200101001
License Number StateNC

VIII. Authorized Official

Name: MRS. GINGER ANN TAULBEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-332-3330