Healthcare Provider Details

I. General information

NPI: 1467810804
Provider Name (Legal Business Name): ACCIDENT TREATMENT CENTER OF GREENSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MARTIN LUTHER KING JR DR SUITE C
GREENSBORO NC
27406-3343
US

IV. Provider business mailing address

2025 MARTIN LUTHER KING JR DR SUITE C
GREENSBORO NC
27406-3343
US

V. Phone/Fax

Practice location:
  • Phone: 335-455-7231
  • Fax: 336-455-7231
Mailing address:
  • Phone: 336-455-7231
  • Fax: 336-455-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINIC ALI HATCHER
Title or Position: OWNER
Credential: D.C.
Phone: 336-455-7231