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General NPI Number Information
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NPI Number | 1033354840
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Entity Type | Organization
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Legal Business Name | GOOD SAMARATAN FAMILY PRACTICE & URGENT CARE, PLLC
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 210 S CLINTON AVE
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City | DUNN
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State | NC
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Zip | 28334-4907
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Country | US
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Telephone | 910-891-7767
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Fax | 910-891-7769
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Provider Business Mailing Address
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Address Line | 210 S CLINTON AVE
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City | DUNN
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State | NC
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Zip | 28334-4907
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Country | US
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Telephone | 910-891-7767
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Fax | 910-891-7769
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. G BROOKS
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Credential |
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Telephone | 910-891-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 103575
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License Number State | NC
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