Facts
- Status
- A
- Credential
- DC
- Type
- Individual
- Enumeration date
- 2018-05-09
- Last updated
- 2021-07-19
Specialties
Licenses
- License NC
- 4890
Location
- Practice location
- 1547 E MARKET ST APT 106
- City
- SMITHFIELD NC
- Postal code
- 275775078
- Phone
- 919-300-7705
Medicare
- PECOS
- No PECOS enrollment row matched 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.