Family Medicine of Harrellsville

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAMILY MEDICINE OF HARRELLSVILLE

Practice address

103 E Main St
Harrellsville, NC 27942-9201

Phone

(252) 356-6544

Fax

(252) 356-9907

NPI assigned

Dec 14, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gaddy Matheson Lassiter, M.D.NPI 1700862083

Title

Ceo

Phone

(252) 356-6544

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gaddy Lassiter, M.D.

  • Family Medicine Physician
  • Harrellsville, NC
  • NPI 1700862083
  NPD (past) Authorized official
• Penny L. Brown, NP

  • Family Nurse Practitioner
  • Ahoskie, NC
  • NPI 1245216449
  NPD (past)
• Peter Beck Woglom, PA-C

  • Medical Physician Assistant
  • Windsor, NC
  • NPI 1639251408
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124003934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 E MAIN ST",
            "city": "HARRELLSVILLE",
            "state": "NC",
            "postal_code": "279429201",
            "telephone_number": "252-356-6544",
            "fax_number": "252-356-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E MAIN ST",
            "city": "HARRELLSVILLE",
            "state": "NC",
            "postal_code": "279429201",
            "telephone_number": "252-356-6544",
            "fax_number": "252-356-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF HARRELLSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LASSITER",
        "authorized_official_first_name": "GADDY",
        "authorized_official_middle_name": "MATHESON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-356-6544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891216W",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS INDIVIDUAL #",
            "identifier": "1216W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cypress Landing Family Care Home
• Cheryl Askew Grace, MA CCC SLP
• Gaddy Lassiter, M.D.

• Family Medicine Physician in Harrellsville, NC
• Providers in Harrellsville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.