Healthcare Provider Details

I. General information

NPI: 1629403050
Provider Name (Legal Business Name): SUSAN JOAN RILEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N CHURCH ST
GREENSBORO NC
27401-1439
US

IV. Provider business mailing address

406 CANTERWOOD DR # 5
MEBANE NC
27302-9701
US

V. Phone/Fax

Practice location:
  • Phone: 336-397-8100
  • Fax:
Mailing address:
  • Phone: 719-250-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12437
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: