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SEASIDE WELLNESS OF SHALLOTTE
NPI 1720458326
Family Medicine in Shallotte, NC

Active since September 25, 2015CLIA 34D1057709 · Waiver
4748 MAIN STREET, SHALLOTTE, NC 28470(910) 754-2273(910) 754-2254 Get Directions Write a Review

NPPES record last updated: April 1, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Seaside Wellness Of Shallotte NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SEASIDE WELLNESS OF SHALLOTTE (NPI 1720458326) is a healthcare organization registered as a family medicine in Shallotte, North Carolina and active in the NPI registry since September 2015. The organization holds a CLIA Waiver certificate valid through August 20, 2026 and lists David K. Moye, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1720458326
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRALEIGH DURHAM MEDICAL GROUP, PA
Location Address4748 MAIN STREETShallotte, NC 28470
Mailing Address5420 Wade Park Blvd, Ste 106Raleigh, NC 27607-4188 · (919) 233-5952 · Fax (919) 854-7774
Phone(910) 754-2273
Fax(910) 754-2254
Organization SubpartYes
Authorized OfficialDavid K. MoyeExecutive Director · (919) 233-5956
Enumeration DateSeptember 25, 2015
Last NPPES UpdateApril 1, 2016
✔ NPI 1720458326 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
4748 MAIN STREET, Shallotte, NC 28470
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Other Names 1

Doing Business AsSeaside Wellness Of Shallotte

Other Identifiers 1

Medicaid1720458326NC

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D1057709

Seaside Wellness Of Shallotte · Shallotte, NC
Active · expires Aug 20, 2026
CLIA Number34D1057709
Laboratory TypePractitioner Other
Certificate Effective DateAugust 21, 2024
Certificate Expiration DateAugust 20, 2026
Laboratory DirectorDeborah C. Varnam
Laboratory Phone(910) 754-2273
Laboratory LocationSeaside Wellness Of Shallotte4503 Main Street Unit 1, Shallotte, NC 28470
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NANCY LEE MURDOCK DNP FNP-BC
Nurse Practitioner (Family)
4748 MAIN STREET
SHALLOTTE, NC 28470
Brunswick County (910) 754-2273
EDWARDS HEALTH PLLC
Clinic/Center (Primary Care)
4748 MAIN STREET
SHALLOTTE, NC 28470
Brunswick County (910) 537-5919

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Raleigh Durham Medical Group, PA's NPI number?

The NPI number for Raleigh Durham Medical Group, PA is 1720458326. It was assigned to this organization in the NPPES registry on September 25, 2015. The provider is doing business as Seaside Wellness Of Shallotte.

Where is Raleigh Durham Medical Group, PA located?

Raleigh Durham Medical Group, PA is located at 4748 Main Street, Shallotte, NC 28470. The listed phone number is (910) 754-2273.

What is Raleigh Durham Medical Group, PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Raleigh Durham Medical Group, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1057709) is associated with this NPI, valid through August 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Raleigh Durham Medical Group, PA was last updated on April 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.