Provider Demographics
NPI:1790234144
Name:FHPG, LLC
Entity Type:Organization
Organization Name:FHPG, LLC
Other - Org Name:FIRSTHEALTH FAMILY MEDICINE - FAYETTEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-4473
Mailing Address - Street 1:2112 SKIBO RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0233
Mailing Address - Country:US
Mailing Address - Phone:910-764-3232
Mailing Address - Fax:910-764-3234
Practice Address - Street 1:2112 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0233
Practice Address - Country:US
Practice Address - Phone:910-764-3232
Practice Address - Fax:910-764-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty