Provider Demographics
NPI: | 1306029830 |
---|---|
Name: | MDFAMILY MEDICAL GROUP |
Entity Type: | Organization |
Organization Name: | MDFAMILY MEDICAL GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AREA DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HATTIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MURPHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-527-6322 |
Mailing Address - Street 1: | 4530 PARK RD STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28209-3790 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-527-6322 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 152 ZEB ROBINSON RD |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27537-3577 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-527-6322 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-06 |
Last Update Date: | 2008-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty |