Healthcare Provider Details

I. General information

NPI: 1083889091
Provider Name (Legal Business Name): WHA MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3343
  • Fax: 910-796-7702
Mailing address:
  • Phone: 910-341-3343
  • Fax: 910-796-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number73991
License Number StateNC

VIII. Authorized Official

Name: MS. BRENDA GAIL HARRIS
Title or Position: DIRECTOR BUSINESS SERVICES
Credential: DIRECTOR
Phone: 910-796-7700