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General NPI Number Information
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NPI Number | 1215325279
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Entity Type | Organization
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Legal Business Name | AHOSKIE ADULT MEDICINE CLINIC, PLLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 233 SOUTH ST W
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City | AHOSKIE
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State | NC
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Zip | 27910-3335
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Country | US
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Telephone | 125-233-2333
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Fax | 252-332-3350
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Provider Business Mailing Address
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Address Line | 233 SOUTH ST W
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City | AHOSKIE
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State | NC
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Zip | 27910-3335
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Country | US
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Telephone | 125-233-2333
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Fax | 252-332-3350
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES BEAUCHAMP
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Credential |
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Telephone | 919-967-9932
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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 | 20100
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License Number State | NC
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