| NPI | 1295959310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A BLAKE Owner 910-754-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 10868) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103290) |
| 363A00000X Physician Assistant (Licence: NC 103296) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2025-09-11 |