Healthcare Provider Details

I. General information

NPI: 1598547010
Provider Name (Legal Business Name): TRIAD PRIMARY HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 09/19/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 ADMIRAL DR STE 104
HIGH POINT NC
27265-1556
US

IV. Provider business mailing address

3750 ADMIRAL DR STE 104
HIGH POINT NC
27265-1556
US

V. Phone/Fax

Practice location:
  • Phone: 336-803-4111
  • Fax: 336-803-4014
Mailing address:
  • Phone: 336-803-4111
  • Fax: 336-803-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTINA STACEY RATLIFF
Title or Position: OWNER
Credential: FNP-C
Phone: 336-803-4111