Healthcare Provider Details

I. General information

NPI: 1487626560
Provider Name (Legal Business Name): GEORGE VAN BUREN HUFFMON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 S 17TH ST SUITE 201
WILMINGTON NC
28401-7515
US

IV. Provider business mailing address

2208 S. 17TH STREET SUITE 201
WILMINGTON NC
28401-7594
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-3333
  • Fax: 910-763-3336
Mailing address:
  • Phone: 910-763-3333
  • Fax: 910-763-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9800571
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: