Healthcare Provider Details

I. General information

NPI: 1124167796
Provider Name (Legal Business Name): COUNTY OF STANLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 1ST ST SUITE 3
ALBEMARLE NC
28001-2819
US

IV. Provider business mailing address

1000 N 1ST ST SUITE 3
ALBEMARLE NC
28001-2819
US

V. Phone/Fax

Practice location:
  • Phone: 704-982-9171
  • Fax: 704-982-8354
Mailing address:
  • Phone: 704-982-9171
  • Fax: 704-982-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D0684540
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberML0765137
License Number StateNC

VIII. Authorized Official

Name: GLENN DAVID JENKINS
Title or Position: HEALTH AND HUMAN SERVICES
Credential:
Phone: 704-982-9171