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General NPI Number Information
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NPI Number | 1699156034
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Entity Type | Organization
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Legal Business Name | HOPE FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 929 N 2ND ST SUITE 201
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City | ALBEMARLE
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State | NC
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Zip | 28001-3363
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Country | US
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Telephone | 704-438-6389
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 984
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City | ALBEMARLE
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State | NC
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Zip | 28002-0984
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH DOUGLAS SHANK
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Credential | DO
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Telephone | 704-438-6389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 210353
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License Number State | NC
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