Provider Demographics
NPI:1306378005
Name:SOUTHPOINT FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:SOUTHPOINT FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-219-3916
Mailing Address - Street 1:1515 W NC HIGHWAY 54 STE 130
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5575
Mailing Address - Country:US
Mailing Address - Phone:984-219-3916
Mailing Address - Fax:919-921-8161
Practice Address - Street 1:1515 W NC HIGHWAY 54 STE 130
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5575
Practice Address - Country:US
Practice Address - Phone:984-219-3916
Practice Address - Fax:919-921-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty