Facts
- Status
- A
- Credential
- D.C.
- Type
- Individual
- Enumeration date
- 2008-09-30
- Last updated
- 2013-11-12
Specialties
Licenses
- License NC
- 3795
Location
- Practice location
- 103 BERNARD COURT
- City
- CHOCOWINITY NC
- Postal code
- 27817
- Phone
- 252-975-6878
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.