Healthcare Provider Details

I. General information

NPI: 1407929094
Provider Name (Legal Business Name): EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W FRIENDLY AVE
GREENSBORO NC
27410-4112
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-852-1915
  • Fax: 336-294-3544
Mailing address:
  • Phone: 336-482-2723
  • Fax: 336-294-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERRI S. JONES
Title or Position: DIRECTOR, EAGLE BUSINESS SERVICES
Credential:
Phone: 336-268-3201