| NPI | 1255880571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENIN PETERS Director Of Contracting And Credent 336-883-0029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208200000X Plastic Surgery |
| 208600000X Surgery | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery | |
| 207QA0000X Family Medicine Adolescent Medicine | |
| 207QA0505X Family Medicine Adult Medicine | |
| 207N00000X Dermatology | |
| 207Q00000X Family Medicine | |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RS0012X Internal Medicine Sleep Medicine | |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2025-03-24 |