Healthcare Provider Details

I. General information

NPI: 1891425930
Provider Name (Legal Business Name): VANCE R WALTON CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

IV. Provider business mailing address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

V. Phone/Fax

Practice location:
  • Phone: 336-333-9081
  • Fax: 336-333-9083
Mailing address:
  • Phone: 336-333-9081
  • Fax: 336-333-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number04891
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: