Healthcare Provider Details

I. General information

NPI: 1528241049
Provider Name (Legal Business Name): MDFAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 FREEMAN MILL RD
GREENSBORO NC
27406-3912
US

IV. Provider business mailing address

4530 PARK RD STE 200
CHARLOTTE NC
28209-3790
US

V. Phone/Fax

Practice location:
  • Phone: 336-412-0013
  • Fax:
Mailing address:
  • Phone: 704-527-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HATTIE MURPHY
Title or Position: AREA DIRECTOR
Credential:
Phone: 704-527-6322