| |
3410 Lainey Ln B Fayetteville NC 28314-2541 | |
(910) 609-1800 | |
(704) 885-9974 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 3410 Lainey Ln, Fayetteville, North Carolina |
Authorized Official Name and Position | Devon Inman (ADMINISTRATOR) |
Authorized Official Contact | 9106091800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 35333 Fayetteville NC 28303-0333 Ph: (910) 609-1800 | 3410 Lainey Ln B Fayetteville NC 28314-2541 Ph: (910) 609-1800 |
NPI Number | 1346672201 |
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Provider Enumeration Date | 08/02/2013 |
Last Update Date | 08/02/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346672201 | NPI | - | NPPES |
3408735 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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