Provider Demographics
NPI:1831429547
Name:FAMILY CLINICPLLC
Entity type:Organization
Organization Name:FAMILY CLINICPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-944-7777
Mailing Address - Street 1:211 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3125
Mailing Address - Country:US
Mailing Address - Phone:910-944-7777
Mailing Address - Fax:910-944-9663
Practice Address - Street 1:211 BROOK RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3125
Practice Address - Country:US
Practice Address - Phone:910-944-7777
Practice Address - Fax:910-944-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty