Organization Name: | MONTGOMERY COUNTY PRIMARY CARE CORP |
NPI Number: | 1376639674 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAE WILLIAMS (DIRECTOR) |
Mailing Address: | 129 Nchighway 109 S Mount Gilead |
State: | NC US |
Postal Code: | 273068941 |
Phone Number: | 9105721979 |
Fax Number: | 9105721961 |
NPI Enumeration Date: | 10/05/2006 |
NPI Last Update Date: | 09/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | School |
Taxonomy Definition: |