Provider Demographics
NPI:1942474507
Name:CHRISTY T PERDUE MD PA
Entity Type:Organization
Organization Name:CHRISTY T PERDUE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-914-0370
Mailing Address - Street 1:619 JEFFERSON ST
Mailing Address - Street 2:PO BOX 1333
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3707
Mailing Address - Country:US
Mailing Address - Phone:910-914-0370
Mailing Address - Fax:910-642-1065
Practice Address - Street 1:619 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3707
Practice Address - Country:US
Practice Address - Phone:910-914-0370
Practice Address - Fax:910-642-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138F4Medicaid
NC138F4OtherBCBS
NCI17979Medicare UPIN
NC89138F4Medicaid