| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 204 Smith Ave, Shallotte, North Carolina |
| Authorized Official Name and Position | William P Walker (OWNER) |
| Authorized Official Contact | 9107556232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 928 Shallotte NC 28459 Ph: (910) 755-6232 | 204 Smith Ave Shallotte NC 28470 Ph: (910) 755-6232 |
| NPI Number | 1811030935 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811030935 | NPI | - | NPPES |
| 8985373 | Medicaid | NC | |
| 85373 | Other | NC | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 9500754 (North Carolina) | Primary |
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Novant Health Medical Group, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 Smith Ave, Shallotte, NC 28470 Phone: 704-384-9672 Fax: 704-316-8725 | |