Provider Demographics
NPI:1740867936
Name:FOLK, DESTINY D (MD)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:D
Last Name:FOLK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6025 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3625
Mailing Address - Country:US
Mailing Address - Phone:919-610-6361
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5871
Practice Address - Country:US
Practice Address - Phone:704-355-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01092627A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300090068Medicaid
IN1104198199OtherANTHEM PTAN