| NPI | 1093359366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALPHONZA FAISON Owner 336-622-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LP2300X Nurse Practitioner, Primary Care | |
| 363LF0000X Nurse Practitioner, Family | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2020-09-22 |