Healthcare Provider Details

I. General information

NPI: 1336102078
Provider Name (Legal Business Name): GREENSBORO MEDICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WESTOVER TER SUITE 201
GREENSBORO NC
27408-7128
US

IV. Provider business mailing address

1511 WESTOVER TER SUITE 201
GREENSBORO NC
27408-7128
US

V. Phone/Fax

Practice location:
  • Phone: 336-373-0611
  • Fax: 336-373-1589
Mailing address:
  • Phone: 336-373-0611
  • Fax: 336-373-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY SHANE ANDERSON
Title or Position: M.D.
Credential: M.D.
Phone: 336-373-0611