Healthcare Provider Details

I. General information

NPI: 1417610627
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD STE 305
GREENSBORO NC
27408-7026
US

IV. Provider business mailing address

719 GREEN VALLEY RD STE 305
GREENSBORO NC
27408-7026
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-5391
  • Fax: 336-275-4702
Mailing address:
  • Phone: 336-275-5391
  • Fax: 336-275-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY HAMMOND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-663-5007