Chicora Medical Group PA
Family Medicine in Supply, NC. Organization (NPI-2).
NPI number1881663227
StatusActive
Last updated in NPPESMar 11, 2008
Details
- NPI
- 1881663227
- Entity type
- Organization (NPI-2)
- Legal business name
- Chicora Medical Group PA
- Organization subpart
- No
- Enumeration date
- Mar 17, 2006
- Last updated
- Mar 11, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Brunswick Speciality Services (Doing Business As)
Practice location
20 Medical Campus DrSte 106b
Supply, NC 28462
Phone 910-754-8600 · Fax 910-755-2364
Mailing address
Po Box 2528Shallotte, NC 28459
Phone 910-754-8600 · Fax 910-755-2364
Authorized official
Bernard Leroy Langston
President
9107548731
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