Healthcare Provider Details
I. General information
NPI: 1225286065
Provider Name (Legal Business Name): HEALTH SCIENCES FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2523 DELANEY RD
WILMINGTON NC
28403-6003
US
IV. Provider business mailing address
2523 DELANEY RD
WILMINGTON NC
28403-6003
US
V. Phone/Fax
- Phone: 910-772-9202
- Fax: 910-772-9452
- Phone: 910-772-9202
- Fax: 910-772-9452
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
ROBERT
L.
HARDYMAN
Title or Position: MANAGER
Credential:
Phone: 910-772-9202