Healthcare Provider Details

I. General information

NPI: 1194842245
Provider Name (Legal Business Name): ALAMANCE FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W HAGGARD AVE
ELON NC
27244-9134
US

IV. Provider business mailing address

812 W HAGGARD AVE
ELON NC
27244-9134
US

V. Phone/Fax

Practice location:
  • Phone: 336-449-4030
  • Fax: 336-449-5315
Mailing address:
  • Phone: 336-449-4030
  • Fax: 336-449-5315

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: SHANNON LANE CUMMINGS
Title or Position: BILLING MANAGER
Credential:
Phone: 336-449-4030