| NPI | 1972915510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA CAPPS MOODY Practice Administrator 336-768-3530 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 202K00000X |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2002-01010) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-08-17 |