Basic Information
| Provider Information | |||||||||
| NPI: | 1881623023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CAROLINA FAMILY DOCTOR, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1728 FORDHAM BLVD | ||||||||
| Address2: | 151 RAMS PLAZA | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199681985 | ||||||||
| FaxNumber: | 9199420038 | ||||||||
| Practice Location | |||||||||
| Address1: | 1728 FORDHAM BLVD | ||||||||
| Address2: | 151 RAMS PLAZA | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199681985 | ||||||||
| FaxNumber: | 9199420038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | WITHROW | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | ASHLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9199681985 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 27884 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.