Provider Demographics
NPI:1588105001
Name:ATKINS FAMILY PRACTICE PA
Entity type:Organization
Organization Name:ATKINS FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROPSHIRE ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-790-7840
Mailing Address - Street 1:1911 S 17TH ST
Mailing Address - Street 2:STE 130A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6662
Mailing Address - Country:US
Mailing Address - Phone:910-790-7840
Mailing Address - Fax:
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:STE 130A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6662
Practice Address - Country:US
Practice Address - Phone:910-790-7840
Practice Address - Fax:910-790-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty