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General NPI Number Information
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NPI Number | 1821151069
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Entity Type | Individual
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Provider Name | MICHAEL GEORGE RALLIS MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 2778 COUNTRY CLUB DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8028
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Country | US
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Telephone | 910-259-5011
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Fax | 910-259-3060
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Provider Business Mailing Address
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Address Line | PO BOX 1179
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City | BURGAW
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State | NC
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Zip | 28425-1179
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Country | US
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Telephone | 910-259-5011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23750
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License Number State | NC
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