Healthcare Provider Details

I. General information

NPI: 1235777913
Provider Name (Legal Business Name): ELIZABETH TILLEY NOTTINGHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NORTHLINE AVE STE 200
GREENSBORO NC
27408-7602
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 336-545-5000
  • Fax:
Mailing address:
  • Phone: 336-545-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: