| NPI | 1558010843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIARA SHACKLEFORD Nurse Practitioner 336-944-9950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 251F00000X Home Infusion |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-22 |