Healthcare Provider Details

I. General information

NPI: 1275586877
Provider Name (Legal Business Name): GENERAL CONFERENCE CORP OF SDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 YPAO RD
TAMUNING GU
96913-3701
US

IV. Provider business mailing address

388 YPAO RD
TAMUNING GU
96913-3701
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8881
  • Fax: 671-646-1292
Mailing address:
  • Phone: 671-646-8881
  • Fax: 671-646-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR SHEPHERD POTTINGER
Title or Position: CEO
Credential:
Phone: 671-646-8881