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General NPI Number Information
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NPI Number | 1851386510
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY MEDICINE, P.A.
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 112 MEDICAL VILLAGE DR UNIT D
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City | WALLACE
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State | NC
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Zip | 28466-1668
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Country | US
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Telephone | 910-285-7592
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Fax | 910-285-4610
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Provider Business Mailing Address
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Address Line | 112 MEDICAL VILLAGE DR UNIT D
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City | WALLACE
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State | NC
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Zip | 28466-1668
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Country | US
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Telephone | 910-285-7592
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Fax | 910-285-4610
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY STEPHEN CRAWFORD
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Credential | M.D.
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Telephone | 910-285-7592
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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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