Deacon Med PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

DEACON MED PA

Practice address

702 S Main St
Randleman, NC 27317-2102

Phone

(336) 545-1515

Fax

(336) 545-4505

NPI assigned

Jan 6, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jerome I Davis, MD

Title

Medical Director

Phone

(336) 545-1515

Specialties & licenses 1

Addresses

Other names 1

• Optimus Medical Center at Randleman Doing business as

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1881998748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S MAIN ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273172102",
            "telephone_number": "336-545-1515",
            "fax_number": "336-545-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S MAIN ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273172102",
            "telephone_number": "336-545-1515",
            "fax_number": "336-545-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACON MED PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "336-545-1515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimus Medical Center at Randleman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Randleman, NC
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; 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.