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General NPI Number Information
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NPI Number | 1154476315
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Entity Type | Organization
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Legal Business Name | 1ST NATIONAL ROCK OF AGES CATHEDRAL
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 430 ALBEMARLE AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27801
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Country | US
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Telephone | 252-985-5981
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Fax | 252-459-5981
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Provider Business Mailing Address
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Address Line | PO BOX 6997 430 ALBEMARLE AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27802
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Country | US
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Telephone | 252-442-1416
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Fax | 252-985-5981
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JIMMY LEE WILLIAMS SR.
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Credential |
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Telephone | 252-452-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HC3277
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License Number State | NC
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