Provider Demographics
NPI:1639181209
Name:GARLICK, WILLIAM LYNNEWOOD JR (M D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LYNNEWOOD
Last Name:GARLICK
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5452
Mailing Address - Country:US
Mailing Address - Phone:919-545-0580
Mailing Address - Fax:919-545-0265
Practice Address - Street 1:200 E SALISBURY ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5452
Practice Address - Country:US
Practice Address - Phone:919-545-0580
Practice Address - Fax:919-545-0265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934563Medicaid
NCEIN562385964OtherTAX ID
NC34563OtherBLUE CROSS
NC34563OtherBLUE CROSS
NC8934563Medicaid