Israel Fornville
Individual provider Active NPI Driver · Greenville, NC
NPI 1275242562 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1275242562
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 7937489 (NC)
- Practice address
- 105 Kimberley Dr
Greenville, NC 27858-6722 - Phone
- (252) 757-1758
- Fax
- (252) 830-0077
- NPI assigned
- Nov 16, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7937489 | NC | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 7937489 | NC | Yes |
Addresses
Primary practice location
105 Kimberley Dr
Greenville, NC 27858-6722
Mailing address
105 Kimberley Dr
Greenville, NC 27858-6722
Phone (252) 757-1758
Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.