Healthcare Provider Details

I. General information

NPI: 1497769103
Provider Name (Legal Business Name): WRIGHTSVILLE FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 39TH STREET
WILMINGTON NC
28403
US

IV. Provider business mailing address

1414 39TH STREET
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 910-792-1231
  • Fax: 910-799-8118
Mailing address:
  • Phone: 910-792-1231
  • Fax: 910-799-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON FERRIS WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-792-1231