Provider Demographics
NPI:1376009787
Name:DAVIDSON RIVER FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:DAVIDSON RIVER FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FOWLER
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-226-1980
Mailing Address - Street 1:325 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3834
Mailing Address - Country:US
Mailing Address - Phone:828-226-1980
Mailing Address - Fax:949-404-6183
Practice Address - Street 1:317 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3898
Practice Address - Country:US
Practice Address - Phone:828-226-1980
Practice Address - Fax:949-404-6183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIDSON RIVER FAMILY MEDICINE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty