Providence Family Practice Associates PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

9501625 Issued in NC

Legal business name

PROVIDENCE FAMILY PRACTICE ASSOCIATES PA

Practice address

1043 Marguerite Drive
Lowell, NC 28098

Phone

(704) 478-6169

Fax

(704) 478-6169

NPI assigned

Jul 6, 2006

Organization subpart

No

Name

Mrs. Tilda Abernathy Jones

Title

Practice Manager

Phone

(704) 478-6169

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528090388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 MARGUERITE DRIVE",
            "city": "LOWELL",
            "state": "NC",
            "postal_code": "28098",
            "telephone_number": "704-478-6169",
            "fax_number": "704-478-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 MARGUERITE DRIVE",
            "city": "LOWELL",
            "state": "NC",
            "postal_code": "28098",
            "telephone_number": "704-478-6169",
            "fax_number": "704-478-6169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY PRACTICE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TILDA",
        "authorized_official_middle_name": "ABERNATHY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "704-478-6169",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9501625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890178L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lowell, NC
• 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.