Healthcare Provider Details

I. General information

NPI: 1093359366
Provider Name (Legal Business Name): FAISON MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 W MARKET ST STE 108
GREENSBORO NC
27409-3432
US

IV. Provider business mailing address

5201 W MARKET ST STE 108
GREENSBORO NC
27409-3432
US

V. Phone/Fax

Practice location:
  • Phone: 336-622-6000
  • Fax:
Mailing address:
  • Phone: 336-622-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALPHONZA FAISON JR.
Title or Position: OWNER
Credential: FNP
Phone: 336-622-6000