Healthcare Provider Details

I. General information

NPI: 1093731671
Provider Name (Legal Business Name): GUILFORD MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 HENRY ST
GREENSBORO NC
27405-3669
US

IV. Provider business mailing address

PO BOX 14944
GREENSBORO NC
27415-4944
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-8911
  • Fax: 336-621-6322
Mailing address:
  • Phone: 336-621-8911
  • Fax: 336-621-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39624
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39624
License Number StateNC

VIII. Authorized Official

Name: KEVIN SIMON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 336-621-8911