Provider Demographics
NPI:1215273628
Name:DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Entity type:Organization
Organization Name:DLP MARIA PARHAM PHYSICIAN PRACTICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-436-1680
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-1680
Mailing Address - Fax:252-492-5707
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 001
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-438-7102
Practice Address - Fax:252-438-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty