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NPI Code Detail

MEDICARE: DIAMOND FAMILY PRACTICE, PLLC

MEDICARE: DIAMOND FAMILY PRACTICE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1780652693
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND FAMILY PRACTICE, PLLC
Provider Business Mailing Address
First Line : 1309 LEES CHAPEL RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2601
Country : US
Telephone Number : 336-286-5505
Fax Number : 336-286-5583
Provider Business Practice Location Address
First Line : 1309 LEES CHAPEL RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2601
Country : US
Telephone Number : 336-286-5505
Fax Number : 336-286-5583
Authorized Official
Title or Position : ORGANIZING MEMBER/OWNER
Name : MRS. KIMBERLY M BOAZE
Credential : N.P.
Telephone Number : 336-601-0812
Provider Enumeration Date : 03/08/2006
Last Update Date : 11/17/2011

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Directions to “DIAMOND FAMILY PRACTICE, PLLC ” Practice Location

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