| NPI | 1215996103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND ALBERT GASKINS, JR. Owner 910-323-3183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9501363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 20544) |
| 207Q00000X Family Medicine (Licence: NC 200825) | |
| 207Q00000X Family Medicine (Licence: NC 201072) | |
| 207Q00000X Family Medicine (Licence: NC 103432) | |
| 207Q00000X Family Medicine (Licence: NC 200500822) | |
| 207Q00000X Family Medicine (Licence: NC 9401111) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2014-08-11 |