Healthcare Provider Details

I. General information

NPI: 1083731780
Provider Name (Legal Business Name): FEMINA WOMEN'S CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 GREEN VALLEY RD SUITE 200
GREENSBORO NC
27408-7041
US

IV. Provider business mailing address

802 GREEN VALLEY RD SUITE 200
GREENSBORO NC
27408-7041
US

V. Phone/Fax

Practice location:
  • Phone: 336-389-9898
  • Fax: 336-275-3550
Mailing address:
  • Phone: 336-389-9898
  • Fax: 336-275-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA JACKSON MOORE
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 336-389-9898