Provider Demographics
NPI:1104805068
Name:EGOLF, FRANKLIN D JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:D
Last Name:EGOLF
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:454 OLD TOM MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28441
Mailing Address - Country:US
Mailing Address - Phone:910-529-9101
Mailing Address - Fax:
Practice Address - Street 1:306 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-4151
Practice Address - Fax:910-862-3470
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000089Medicaid
NC6000089Medicaid