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General NPI Number Information
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NPI Number | 1780706291
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Entity Type | Organization
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Legal Business Name | MULTISPECIALTY PHYSICIAN SERVICES GROUP LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 4380 FAYETTEVILLE RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2677
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Country | US
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Telephone | 910-618-1644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80552
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City | RALEIGH
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State | NC
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Zip | 27623-0552
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Country | US
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Telephone | 910-618-1644
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Fax |
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Authorized Official
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Title or Position | INSURANCE
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Name | MRS. SHAREN HAMMONDS
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Credential |
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Telephone | 910-618-1644
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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 | 26678
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License Number State | NC
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