Provider Demographics
NPI:1881848547
Name:PORT CITY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PORT CITY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-762-1190
Mailing Address - Street 1:1612 DOCTOR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-762-1190
Mailing Address - Fax:910-762-1196
Practice Address - Street 1:1612 DOCTOR CIRCLE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-762-1190
Practice Address - Fax:910-762-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947541Medicaid
NCG23917OtherUPIN
NC8947541Medicaid