Provider Demographics
NPI:1912320169
Name:JOHNSTON PRIMARY CARE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:JOHNSTON PRIMARY CARE PHYSICIAN SERVICES, INC.
Other - Org Name:JOHNSTON MEDICAL ASSOCIATES - INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7374
Mailing Address - Street 1:514 N BRIGHTLEAF BLVD
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-938-7182
Mailing Address - Fax:919-938-7185
Practice Address - Street 1:514 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 1620
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7182
Practice Address - Fax:919-938-7185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty