Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-09-02
- Last updated
- 2026-09-15
Specialties
Licenses
- License NC
- 200101317
Location
- Practice location
- 713 WILKINS ST
- City
- SMITHFIELD NC
- Postal code
- 275774647
- Phone
- 919-934-1211
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.