Healthcare Provider Details

I. General information

NPI: 1427450311
Provider Name (Legal Business Name): FAMILY SERVICE OF THE PIEDMONT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WASHINGTON ST
GREENSBORO NC
27401-2911
US

IV. Provider business mailing address

902 BONNER DR
JAMESTOWN NC
27282-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-387-6161
  • Fax: 336-387-9167
Mailing address:
  • Phone: 336-889-6105
  • Fax: 336-387-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number201930
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201930
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201930
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201930
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201930
License Number StateNC

VIII. Authorized Official

Name: MR. THOMAS FOSTER CAMPBELL
Title or Position: PRESIDENT/CEO
Credential: LPC
Phone: 336-889-6105