Provider Demographics
NPI:1922464213
Name:DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:DLP CENTRAL CAROLINA PHYSICIAN PRACTICES LLC
Other - Org Name:THE WOMAN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:1781 TATE BLVD SE
Mailing Address - Street 2:STE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4251
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:STE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:615-920-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty