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General NPI Number Information
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NPI Number | 1164672515
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Entity Type | Organization
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Legal Business Name | ANGEL FAMILY PRACTICE
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 201 EAST LIVERMORE DRIVE
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City | PEMBROKE
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State | NC
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Zip | 28372
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Country | US
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Telephone | 910-272-6422
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Fax | 910-521-4237
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Provider Business Mailing Address
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Address Line | 201 LIVERMORE DR
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City | PEMBROKE
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State | NC
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Zip | 28372-7322
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Country | US
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Telephone | 910-272-6422
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Fax | 910-521-4237
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. DAWN TRACY LANGLEY
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Credential | PA-C
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Telephone | 910-272-6422
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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 | 102637
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License Number State | NC
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