Healthcare Provider Details

I. General information

NPI: 1760452676
Provider Name (Legal Business Name): EDITH ELAINE CLOUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12925 HIGHWAY 601 MIDLAND FAMILY MEDICINE
MIDLAND NC
28107-9536
US

IV. Provider business mailing address

12925 HIGHWAY 601 MIDLAND FAMILY MEDICINE
MIDLAND NC
28107-9536
US

V. Phone/Fax

Practice location:
  • Phone: 704-888-3702
  • Fax: 704-888-4192
Mailing address:
  • Phone: 704-888-3702
  • Fax: 704-888-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9900190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: