Healthcare Provider Details

I. General information

NPI: 1528578143
Provider Name (Legal Business Name): ESSENTIAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 N ELAM AVE STE 101
GREENSBORO NC
27403-1132
US

IV. Provider business mailing address

526 N ELAM AVE STE 101
GREENSBORO NC
27403-1132
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-2520
  • Fax:
Mailing address:
  • Phone: 336-274-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID R GIBSON
Title or Position: PRESIDENT
Credential:
Phone: 336-274-2520