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Organization

FAYETTEVILLE OTOLARYNGOLOGY HEAD AND NECK SURGERY P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. GWENDOLYN C PARKS (ADMINISTRATOR)
(910) 323-1463
Entity
Organization

Contact information

Practice address
1839 QUIET CV, FAYETTEVILLE, NC 28304-3857
(910) 323-1463
(910) 323-1575
Mailing address
1839 QUIET CV, FAYETTEVILLE, NC 28304-3857
(910) 323-1463
(910) 323-1575

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0130C
BCBS OF NC
NC
05
890130C
NC
01
CA7111
RAILROAD MEDICARE
NC
Enumeration date
07/19/2006
Last updated
10/22/2007
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