Healthcare Provider Details

I. General information

NPI: 1194481416
Provider Name (Legal Business Name): CENTER FOR INTEGRATED MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3822 N ELM ST STE 102
GREENSBORO NC
27455-2596
US

IV. Provider business mailing address

3822 N ELM ST STE 102
GREENSBORO NC
27455-2596
US

V. Phone/Fax

Practice location:
  • Phone: 336-541-8120
  • Fax: 336-541-8130
Mailing address:
  • Phone: 336-541-8120
  • Fax: 336-541-8130

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: OLUGBEMIGA JEGEDE
Title or Position: NP SUPERVISOR
Credential: MD
Phone: 810-908-9996