Provider Demographics
NPI:1821058017
Name:CENTER FOR FAMILY MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-349-5062
Mailing Address - Street 1:55 HOLLY SPRINGS PARK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-0719
Mailing Address - Country:US
Mailing Address - Phone:828-349-3550
Mailing Address - Fax:828-349-5084
Practice Address - Street 1:55 HOLLY SPRINGS PARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-0719
Practice Address - Country:US
Practice Address - Phone:828-349-3550
Practice Address - Fax:828-349-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890159UMedicaid
NC0159UOtherBLUE CROSS BLUE SHIELD
NC2326142Medicare ID - Type Unspecified