Healthcare Provider Details

I. General information

NPI: 1184394520
Provider Name (Legal Business Name): GENERATIONS FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 JONES FERRY RD STE 102
CARRBORO NC
27510-6113
US

IV. Provider business mailing address

1021 DARRINGTON DR STE 101
CARY NC
27513-8158
US

V. Phone/Fax

Practice location:
  • Phone: 919-929-1747
  • Fax: 919-929-4862
Mailing address:
  • Phone: 984-333-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY RENEE LONG
Title or Position: PRACTICE IMPLEMENTATION MANAGER
Credential:
Phone: 984-333-2741