MEDICARE: ALBEMARLE MENTAL HEALTH CENTER

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	103G00000X	Clinical Neuropsychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902951163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	160-A CAMDEN MEDICAL PARK
Second Line	:
City	:	CAMDEN
State	:	NC
Zip	:	27921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160-A CAMDEN MEDICAL PARK
Second Line	:
City	:	CAMDEN
State	:	NC
Zip	:	27921
Country	:	US
Telephone Number	:	252-335-5158
Fax Number	:

Authorized Official
Title or Position	:	AREA DIRECTOR
Name	:	CHARLES FRANKLIN JR.
Credential	:
Telephone Number	:	252-335-1113

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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