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General NPI Number Information
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NPI Number | 1619453537
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Entity Type | Organization
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Legal Business Name | PHYSICIAN CARE DIRECT, LLC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 223 WONDERLAND TRL
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City | BLOWING ROCK
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State | NC
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Zip | 28605-6376
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Country | US
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Telephone | 855-723-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1457 KELLY RD # 112
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City | APEX
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State | NC
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Zip | 27502-9572
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Country | US
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Telephone | 855-723-2300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM THOMAS LAWSON JR.
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Credential | MD
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Telephone | 855-723-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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