Provider Demographics
NPI:1164528709
Name:AZALEA PRIMARY CARE
Entity Type:Organization
Organization Name:AZALEA PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-297-0137
Mailing Address - Street 1:422 STRADLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1232
Mailing Address - Country:US
Mailing Address - Phone:910-297-0137
Mailing Address - Fax:
Practice Address - Street 1:422 STRADLEIGH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1232
Practice Address - Country:US
Practice Address - Phone:910-297-0137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty