Healthcare Provider Details

I. General information

NPI: 1518844190
Provider Name (Legal Business Name): FRESH START PRIMARY CARE AND OUTPATIENT RECOVERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 MEETING CT
WILMINGTON NC
28401-6631
US

IV. Provider business mailing address

1906 MEETING CT
WILMINGTON NC
28401-6631
US

V. Phone/Fax

Practice location:
  • Phone: 910-399-7180
  • Fax:
Mailing address:
  • Phone: 910-399-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAX BRANDON LUDLUM
Title or Position: PA/OWNER
Credential: PA
Phone: 877-603-6199