Provider Demographics
NPI:1790810562
Name:GOLDSBORO PSYCHIATRIC CLINIC PA
Entity Type:Organization
Organization Name:GOLDSBORO PSYCHIATRIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOEPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-736-4722
Mailing Address - Street 1:1506 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2202
Mailing Address - Country:US
Mailing Address - Phone:919-736-4722
Mailing Address - Fax:919-734-3442
Practice Address - Street 1:1506 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE H
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2202
Practice Address - Country:US
Practice Address - Phone:919-736-4722
Practice Address - Fax:919-734-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014EOtherBLUE CROSS BLUE SHIELD
NC014EOtherBLUE CROSS BLUE SHIELD