Healthcare Provider Details

I. General information

NPI: 1770566846
Provider Name (Legal Business Name): PIEDMONT SENIOR CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N ELM STREET
GREENSBORO NC
27401
US

IV. Provider business mailing address

1309 N ELM STREET
GREENSBORO NC
27401
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-5400
  • Fax: 336-544-5401
Mailing address:
  • Phone: 336-544-5400
  • Fax: 336-544-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. AMELITA SAMERA RODRIGUEZ
Title or Position: HR/BM
Credential:
Phone: 336-544-5400