Basic Information
| Provider Information | |||||||||
| NPI: | 1306960216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | SUMNER | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 SOUTH BENNETT STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106924821 | ||||||||
| FaxNumber: | 9106926110 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 BLUE RIDGE RD STE 417 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197879097 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2007 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 102990 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.