Healthcare Provider Details

I. General information

NPI: 1851859037
Provider Name (Legal Business Name): TONYA GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 WINSTON ROAD
JONESVILLE NC
28642
US

IV. Provider business mailing address

1783 PEBBLE RUN LN
CLEMMONS NC
27012-7437
US

V. Phone/Fax

Practice location:
  • Phone: 336-526-0037
  • Fax:
Mailing address:
  • Phone: 336-701-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011518
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: