MEDICARE: DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1124485768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC

Provider Business Mailing Address
First Line	:	210 13TH AVENUE PL NW
Second Line	:	STE 101
City	:	HICKORY
State	:	NC
Zip	:	28601-2568
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 13TH AVENUE PL NW
Second Line	:	STE 101
City	:	HICKORY
State	:	NC
Zip	:	28601-2568
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESS JUDY
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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