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General NPI Number Information
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NPI Number | 1134106032
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE OF SUMMERFIELD PLLC
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 4431 HIGHWAY 220 NORTH
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City | SUMMERFIELD
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State | NC
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Zip | 27358-9411
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Country | US
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Telephone | 336-643-7711
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Fax | 336-643-3047
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | SUMMERFIELD
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State | NC
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Zip | 27358-0220
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Country | US
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Telephone | 336-643-7711
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Fax | 336-643-3047
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | BRENT A BURNETT
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Credential | MD
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Telephone | 336-643-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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