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General NPI Number Information
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NPI Number | 1609918937
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Entity Type | Organization
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Legal Business Name | SHIPYARD MEDICAL CENTER
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2632 CAROLINA BEACH RD SUITE C
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City | WILMINGTON
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State | NC
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Zip | 28412-1806
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Country | US
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Telephone | 919-931-0490
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Fax | 910-796-1177
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Provider Business Mailing Address
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Address Line | 2632 CAROLINA BEACH RD SUITE C
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City | WILMINGTON
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State | NC
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Zip | 28412-1806
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Country | US
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Telephone | 919-931-0490
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Fax | 910-796-1177
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BETTY G. MACKIE
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Credential |
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Telephone | 919-931-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | NC 102817
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License Number State | NC
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