Basic Information
| Provider Information | |||||||||
| NPI: | 1831168103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ARTS FAMILY PRACTICE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 OWEN DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103239111 | ||||||||
| FaxNumber: | 9104842535 | ||||||||
| Practice Location | |||||||||
| Address1: | 413 OWEN DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103239111 | ||||||||
| FaxNumber: | 9104842535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | HINMAN | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9103239111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60921 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 207Q00000X | 01 | TAXONOMY | OTHER |