Healthcare Provider Details

I. General information

NPI: 1518996677
Provider Name (Legal Business Name): GREENSBORO DIABETES SELF CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N CHURCH ST SUITE 400
GREENSBORO NC
27401-1439
US

IV. Provider business mailing address

1002 N CHURCH ST SUITE 400
GREENSBORO NC
27401-1439
US

V. Phone/Fax

Practice location:
  • Phone: 336-378-1076
  • Fax: 336-378-0867
Mailing address:
  • Phone: 336-378-1076
  • Fax: 336-378-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERION A GODWIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-378-1076