Healthcare Provider Details

I. General information

NPI: 1225017544
Provider Name (Legal Business Name): HARRY TURNER HULBERT III PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 BETHABARA RD
WINSTON SALEM NC
27106-3375
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-759-7596
  • Fax:
Mailing address:
  • Phone: 336-759-7596
  • Fax: 336-759-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000101889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: