Provider Demographics
NPI:1033885355
Name:MT OLIVE CHURCH OF CHRIST
Entity Type:Organization
Organization Name:MT OLIVE CHURCH OF CHRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PASTORAL COUNSELOR
Authorized Official - Phone:252-484-2286
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0661
Mailing Address - Country:US
Mailing Address - Phone:252-482-1540
Mailing Address - Fax:
Practice Address - Street 1:426 HAUGHTON RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9464
Practice Address - Country:US
Practice Address - Phone:252-482-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution