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General NPI Number Information
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NPI Number | 1306378005
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Entity Type | Organization
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Legal Business Name | SOUTHPOINT FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 1515 W NC HIGHWAY 54 STE 130
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City | DURHAM
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State | NC
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Zip | 27707-5575
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Country | US
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Telephone | 984-219-3916
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Fax | 919-921-8161
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Provider Business Mailing Address
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Address Line | 1515 W NC HIGHWAY 54 STE 130
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City | DURHAM
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State | NC
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Zip | 27707-5575
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Country | US
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Telephone | 984-219-3916
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Fax | 919-921-8161
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MRS. CHRYSTAL PIKE
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Credential |
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Telephone | 984-219-3916
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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 | 225780
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License Number State | NC
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