Healthcare Provider Details

I. General information

NPI: 1760729644
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MAPLE ST
GREENSBORO NC
27405-6911
US

IV. Provider business mailing address

1204 MAPLE ST
GREENSBORO NC
27405-6911
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-8258
  • Fax: 336-292-4109
Mailing address:
  • Phone: 336-294-8258
  • Fax: 336-292-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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