Healthcare Provider Details

I. General information

NPI: 1700901832
Provider Name (Legal Business Name): GREENSBORO ENDOCRINOLOGY AND DIABETES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N. CHURCH STREET SUITE 400
GREENSBORO NC
27401-1450
US

IV. Provider business mailing address

1002 N. CHURCH STREET SUITE 400
GREENSBORO NC
27401-1450
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-1076
  • Fax: 336-378-0867
Mailing address:
  • Phone: 336-378-1076
  • Fax: 336-378-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number136691
License Number StateNC

VIII. Authorized Official

Name: CHARLES G. GEGICK
Title or Position: PARTNER
Credential: M.D.
Phone: 336-378-1076