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General NPI Number Information
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NPI Number | 1639857923
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Entity Type | Organization
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Legal Business Name | OUR TOWN PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 463 SECOND ST
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City | AYDEN
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State | NC
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Zip | 28513-7179
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Country | US
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Telephone | 252-714-8224
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 133
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City | AYDEN
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State | NC
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Zip | 28513-0133
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Country | US
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Telephone | 252-714-8224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDY JONES GALLOWAY
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Credential | NP
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Telephone | 252-714-8224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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