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NPI Code Detail

MEDICARE: MATTIE THOMPSON PRICE PA-C

MEDICARE:   MATTIE THOMPSON PRICE  PA-C
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
1363A00000XPhysician Assistant1188145NC

General Provider Information

NPI Number : 1265005375
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTIE THOMPSON PRICE PA-C
Provider Business Mailing Address
First Line : 430 DAVIS DR STE 180
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-6802
Country : US
Telephone Number : 919-375-2366
Fax Number : 919-375-7722
Provider Business Practice Location Address
First Line : 430 DAVIS DR STE 180
Second Line :
City : MORRISVILLE
State : NC
Zip : 27560-6802
Country : US
Telephone Number : 919-375-2366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2021
Last Update Date : 04/10/2026

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Directions to “ MATTIE THOMPSON PRICE PA-C” Practice Location

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