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General NPI Number Information
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NPI Number | 1407875610
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 1905 GLEN MEADE RD
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City | WILMINGTON
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State | NC
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Zip | 28403-6024
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Country | US
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Telephone | 910-763-6251
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Fax | 910-763-7408
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Provider Business Mailing Address
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Address Line | 1905 GLEN MEADE RD
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City | WILMINGTON
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State | NC
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Zip | 28403-6024
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Country | US
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Telephone | 910-763-6251
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Fax | 910-763-7408
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | AMY ARLENE WATSON
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Credential |
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Telephone | 910-763-6251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40206
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License Number State | NC
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