MEDICARE: FAMILY URGENT CARE OF AMERICA, INC

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1972657302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY URGENT CARE OF AMERICA, INC

Provider Business Mailing Address
First Line	:	502 NORTH HIGHWAY 17
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445
Country	:	US
Telephone Number	:	910-329-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 NORTH HIGHWAY 17
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445
Country	:	US
Telephone Number	:	910-329-2721
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EARLIE JOHNSON JR.
Credential	:	M.D.
Telephone Number	:	910-346-1188

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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