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General NPI Number Information
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NPI Number | 1518844190
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Entity Type | Organization
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Legal Business Name | FRESH START PRIMARY CARE & OUTPATIENT RECOVERY P.A.
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1906 MEETING CT
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City | WILMINGTON
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State | NC
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Zip | 28401-6631
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Country | US
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Telephone | 910-399-7180
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 MEETING CT
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City | WILMINGTON
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State | NC
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Zip | 28401-6631
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Country | US
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Telephone | 910-399-7180
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAX BRANDON LUDLUM
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Credential | PA-X
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Telephone | 910-399-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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