| NPI | 1285734319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL DWIGHT BLACKWELL Owner/Provider 919-367-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 32989) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103581) |
| 363L00000X Nurse Practitioner (Licence: NC 0050-01104) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |