| NPI | 1487727459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE DOUGHERTY Credentialer/Billing COO Rdinator 336-246-9449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 261QP0905X Clinic/Center Public Health, State or Local |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-06-16 |