Healthcare Provider Details

I. General information

NPI: 1457436982
Provider Name (Legal Business Name): EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 NEW GARDEN RD
GREENSBORO NC
27410-2721
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-6190
  • Fax: 336-294-6278
Mailing address:
  • Phone: 336-294-6190
  • Fax: 336-294-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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