Organization
CAPE FEAR OTOLARYNGOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE JOHNSON (PRACTICE ADMINISTRATOR)
(910) 323-9222
Entity
Organization
Contact information
Practice address
2053 VALLEYGATE DRIVE, SUITE 101, FAYETTEVILLE, NC 28304-3688
(910) 323-9222
(910) 221-9220
Mailing address
2053 VALLEYGATE DRIVE, SUITE 101, FAYETTEVILLE, NC 28304-3688
(910) 323-9222
(910) 221-9220
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
332S00000X
Hearing Aid Equipment
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7001503
—
NC
Enumeration date
10/06/2008
Last updated
10/06/2008
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