Healthcare Provider Details

I. General information

NPI: 1013086321
Provider Name (Legal Business Name): EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W FRIENDLY AVE STE 200
GREENSBORO NC
27410-4368
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-373-1996
  • Fax: 336-482-2320
Mailing address:
  • Phone: 336-482-2300
  • Fax: 336-482-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRI S. JONES
Title or Position: DIRECTOR, EAGLE BUSINESS SERVICES
Credential:
Phone: 336-268-3201