Healthcare Provider Details

I. General information

NPI: 1295939221
Provider Name (Legal Business Name): EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE SUITE 300
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-268-3385
  • Fax: 336-268-3381
Mailing address:
  • Phone: 336-268-3385
  • Fax: 336-268-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI S. JONES
Title or Position: DIRECTOR, EAGLE BUSINESS SERVICES
Credential:
Phone: 336-268-3201