Provider Demographics
NPI:1669035879
Name:FAMILY FIRST MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:980-218-9210
Mailing Address - Street 1:1940 S MINT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4629
Mailing Address - Country:US
Mailing Address - Phone:704-315-8277
Mailing Address - Fax:704-379-1824
Practice Address - Street 1:4920 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6618
Practice Address - Country:US
Practice Address - Phone:980-218-9210
Practice Address - Fax:980-218-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty