Provider Demographics
NPI:1326000969
Name:PERKINS, GWENDOLYN MYRTIS (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:MYRTIS
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-0192
Mailing Address - Country:US
Mailing Address - Phone:704-694-6700
Mailing Address - Fax:704-694-5454
Practice Address - Street 1:1111 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-289-8537
Practice Address - Fax:704-283-4602
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7966809Medicaid
SCN24488Medicaid
080120357OtherRAILROAD MEDICARE
NC66809OtherBCBS NC
NC7966809Medicaid
080120357OtherRAILROAD MEDICARE