Active NPI
Richard Vernon Liles Jr., MD
- Family Medicine Physician
- Albemarle, NC
National Provider Identifier
1023133261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10861
- Practice address
- 220 Yadkin St
Community Care Clinic
Albemarle, NC 28001 - Phone
- (704) 984-2300
- Fax
- (704) 984-4671
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10861 | NC | Primary |
Addresses
Primary practice location
220 Yadkin St
Community Care Clinic
Albemarle, NC 28001
Mailing address
505 Pee Dee Ave
Albemarle, NC 28001
Phone (704) 984-2300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10861 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023133261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 PEE DEE AVE",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "28001",
"telephone_number": "704-984-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 YADKIN ST",
"address_2": "COMMUNITY CARE CLINIC",
"city": "ALBEMARLE",
"state": "NC",
"postal_code": "28001",
"telephone_number": "704-984-2300",
"fax_number": "704-984-4671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILES",
"first_name": "RICHARD",
"middle_name": "VERNON",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "10861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albemarle, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.