| Organization Name: | AHOSKIE ADULT MEDICINE CLINIC, PLLC |
| NPI Number: | 1215325279 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES BEAUCHAMP (OWNER) |
| Mailing Address: | 233 South St W Ahoskie |
| State: | NC US |
| Postal Code: | 279103335 |
| Phone Number: | 1252332333 |
| Fax Number: | 2523323350 |
| NPI Enumeration Date: | 12/29/2014 |
| NPI Last Update Date: | 05/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 20100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |