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General NPI Number Information
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NPI Number | 1922853514
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Entity Type | Organization
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Legal Business Name | KOG INTEGRATED HEALTHCARE
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 810 ELM ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4152
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Country | US
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Telephone | 984-229-9005
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Fax | 919-362-0769
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Provider Business Mailing Address
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Address Line | 810 ELM ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4152
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Country | US
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Telephone | 984-229-9005
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Fax | 919-362-0769
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Authorized Official
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Title or Position | MD/OWNER
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Name | DAVID PARKER
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Credential |
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Telephone | 984-229-9005
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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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