Organization
PRIVATE DIAGNOSTIC CLINIC, PLLC
Active
Other names
Duke Health Center of Smithfield
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER THOMAS FREDERICK (CFO)
(919) 613-7762
Entity
Organization
Contact information
Practice address
507 N BRIGHTLEAF BLVD, SUITE 100, SMITHFIELD, NC 27577-4405
(919) 684-8111
Mailing address
PO BOX 110566, DURHAM, NC 27709-5566
(919) 620-4855
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0174U
GRP
NC
01
—
1029437033
TRICARE GRP
—
05
—
790174U
—
NC
Enumeration date
07/09/2006
Last updated
07/11/2022
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