# MOUNT JEFFERSON FAMILY MEDICINE, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114959731
- **Authorized official:** RITA D RICHARDSON (CORPORATE SECRETARY)
- **Authorized official phone:** (336) 846-7433

## Contact information

- **Practice address:** 200 HOSPITAL AVE, SUITE 3, JEFFERSON, NC 28640-9244
- **Practice address phone:** (336) 846-7433
- **Practice address fax:** (336) 846-7878
- **Mailing address:** PO BOX 369, JEFFERSON, NC 28640-0369
- **Mailing address phone:** (336) 846-7433
- **Mailing address fax:** (336) 846-7878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 12/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0173A | BCBSNC | NC |
| 05 | — | 790173A | — | NC |