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Individual

DR. MARY LOU CHURCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1707 INDUSTRIAL DR, WILKESBORO, NC 28697-7345
(336) 667-6363
(336) 667-8066
Mailing address
1707 INDUSTRIAL DR, WILKESBORO, NC 28697-7345
(336) 667-6363
(336) 667-8066

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39371
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
65316
BCBS PROVIDER NUMBER
NC
05
8965316
NC
Enumeration date
08/10/2005
Last updated
07/09/2007
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