Healthcare Provider Details

I. General information

NPI: 1699196295
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 NC HIGHWAY 66 S SUITE 101
KERNERSVILLE NC
27284-3828
US

IV. Provider business mailing address

PO BOX 745032
ATLANTA GA
30374-5032
US

V. Phone/Fax

Practice location:
  • Phone: 336-993-2224
  • Fax:
Mailing address:
  • Phone: 888-563-3282
  • Fax: 605-677-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500628
License Number StateNC

VIII. Authorized Official

Name: SALLY HAMMOND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-663-5007