Healthcare Provider Details

I. General information

NPI: 1205892890
Provider Name (Legal Business Name): GUILFORD NEUROLOGIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 THIRD STREET SUITE 101
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

PO BOX 29568
GREENSBORO NC
27429-9568
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-2511
  • Fax: 336-370-0287
Mailing address:
  • Phone: 336-273-2511
  • Fax: 336-370-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number041013491
License Number StateNC

VIII. Authorized Official

Name: MRS. NANCY E. SKELTON
Title or Position: ADMINISTRATOR
Credential: MBA, MHA, CMPE
Phone: 336-272-2511