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General NPI Number Information
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NPI Number | 1134348998
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Entity Type | Organization
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Legal Business Name | WARRENTON FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 163 CHRISTMAS RD
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City | WARRENTON
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State | NC
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Zip | 27589-8723
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Country | US
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Telephone | 252-257-0372
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Fax |
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Provider Business Mailing Address
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Address Line | 163 CHRISTMAS RD
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City | WARRENTON
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State | NC
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Zip | 27589-8723
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Country | US
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Telephone | 252-257-0372
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN MEMBER
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Name | DR. YVETTE RENEE DOUGLAS-LEWIS
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Credential | M.D.
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Telephone | 252-257-0372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 137051
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License Number State | NC
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