Healthcare Provider Details

I. General information

NPI: 1689630469
Provider Name (Legal Business Name): PRIMEDOC OF RANDOLPH COUNTY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

PO BOX 75577
CHARLOTTE NC
28275-0577
US

V. Phone/Fax

Practice location:
  • Phone: 843-237-3378
  • Fax: 843-237-5073
Mailing address:
  • Phone: 843-237-3378
  • Fax: 843-237-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT REYNOLDS
Title or Position: PRESIDENT
Credential: MD
Phone: 828-210-3260