Basic Information
| Provider Information | |||||||||
| NPI: | 1740530112 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CAROLINA COMMUNITY FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742272 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197760130 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 WILKINS DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273307268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197766000 | ||||||||
| FaxNumber: | 9197760130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 06/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4042655009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.