Healthcare Provider Details

I. General information

NPI: 1356224018
Provider Name (Legal Business Name): TAWANNA A ARCHIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S ELM ST STE 6
GREENSBORO NC
27401-2792
US

IV. Provider business mailing address

1400 RANDOLPH AVE
GREENSBORO NC
27406-2331
US

V. Phone/Fax

Practice location:
  • Phone: 980-208-0776
  • Fax:
Mailing address:
  • Phone: 980-208-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number8713028
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: