Provider Demographics
NPI:1588205397
Name:WILMINGTON FAMILY PRACTICE
Entity Type:Organization
Organization Name:WILMINGTON FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-538-6228
Mailing Address - Street 1:201 N FRONT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4055
Mailing Address - Country:US
Mailing Address - Phone:910-500-6451
Mailing Address - Fax:910-500-5864
Practice Address - Street 1:201 N FRONT ST STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4055
Practice Address - Country:US
Practice Address - Phone:910-500-6451
Practice Address - Fax:910-500-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty