Basic Information
| Provider Information | |||||||||
| NPI: | 1053402230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DECHURCH | ||||||||
| FirstName: | FRANCES | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365644866 | ||||||||
| FaxNumber: | 3362776815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 KERNERSVILLE MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272847146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365644866 | ||||||||
| FaxNumber: | 3365644869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 9300679 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207R00000X | 9300679 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 9300679 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 276066 | 01 | NC | MAMSI PROFESSIONAL | OTHER | 891065K | 05 | NC | MEDICAID | 28082 | 01 | NC | NC BLUE SHIELD | OTHER |