Basic Information
| Provider Information | |||||||||
| NPI: | 1679924344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCJUNKINS | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | LEE ROACH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 ENGLISH RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278046027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 ENGLISH RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278046027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2016 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 208600000X | LL39563 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 208D00000X | 2018-01199 | NC | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | LL39563 | 01 | SC | LIMITED LICENSE | OTHER | 39563 | 01 | SC | MEDICAL LICENSE | OTHER |