Provider Demographics
NPI:1427097823
Name:GOLDSBORO FAMILY PHYSICIANS, P.A.
Entity type:Organization
Organization Name:GOLDSBORO FAMILY PHYSICIANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-735-1251
Mailing Address - Street 1:1108 PARKWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9429
Mailing Address - Country:US
Mailing Address - Phone:919-735-1251
Mailing Address - Fax:919-734-5183
Practice Address - Street 1:1108 PARKWAY DR STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9429
Practice Address - Country:US
Practice Address - Phone:919-735-1251
Practice Address - Fax:919-734-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790150CMedicaid
NC0150COtherBLUE CROSS BLUE SHIELD NC
NCG95748Medicare UPIN
NC790150CMedicaid
NCF33955Medicare UPIN
NC2316260Medicare ID - Type UnspecifiedGOLDSBORO FAMILY PHYS