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General NPI Number Information
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NPI Number | 1316345127
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Entity Type | Organization
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Legal Business Name | SOUTH COURT MEDICAL CARE PA
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 217 E ELM ST
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City | GRAHAM
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State | NC
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Zip | 27253-3021
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Country | US
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Telephone | 336-228-9671
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Fax | 336-228-9674
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Provider Business Mailing Address
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Address Line | 217 E ELM ST
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City | GRAHAM
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State | NC
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Zip | 27253-3021
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Country | US
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Telephone | 336-228-9671
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Fax | 336-228-9674
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY SYKES
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Credential | PA
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Telephone | 336-228-9671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 205972
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License Number State | NC
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