Healthcare Provider Details

I. General information

NPI: 1720120637
Provider Name (Legal Business Name): NORTH CAROLINA A&T STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N. BENBOW ROAD
GREENSBORO NC
27411
US

IV. Provider business mailing address

1601 E MARKET STREET
GREENSBORO NC
27411
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-7880
  • Fax: 336-256-2613
Mailing address:
  • Phone: 336-334-7880
  • Fax: 336-256-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETTYE YOUNG-STEWART
Title or Position: INTERIM STUDENT HEALTH CENTER DIREC
Credential:
Phone: 336-334-7880