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General NPI Number Information
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NPI Number | 1831429547
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Entity Type | Organization
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Legal Business Name | FAMILY CLINICPLLC
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 211 BROOK RD
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City | ABERDEEN
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State | NC
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Zip | 28315-3125
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Country | US
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Telephone | 910-944-7777
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Fax | 910-944-9663
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Provider Business Mailing Address
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Address Line | 211 BROOK RD
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City | ABERDEEN
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State | NC
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Zip | 28315-3125
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Country | US
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Telephone | 910-944-7777
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Fax | 910-944-9663
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. ROGER D WADDELL
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Credential | MD
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Telephone | 910-944-7777
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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 |
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License Number State |
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