Provider Demographics
NPI:1811016280
Name:ESSIE F DAUGHTRY
Entity Type:Organization
Organization Name:ESSIE F DAUGHTRY
Other - Org Name:FREEMAN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR FOR CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:252-355-0355
Mailing Address - Street 1:506 SEDGEFIELD DR
Mailing Address - Street 2:PO.BOX7271
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6477
Mailing Address - Country:US
Mailing Address - Phone:125-235-5035
Mailing Address - Fax:125-235-5035
Practice Address - Street 1:506 SEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6477
Practice Address - Country:US
Practice Address - Phone:125-235-5035
Practice Address - Fax:125-235-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-074-009261QA0005X
NCFCL-074-013261QA0005X
NCFCL-074-016261QA0005X
NCFCL-074-015261QA0005X
NCFCL074-010261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801953Medicaid
NC7801954Medicaid
NC7801955Medicaid
NC7802176Medicaid
NC7802177Medicaid