Healthcare Provider Details

I. General information

NPI: 1225501877
Provider Name (Legal Business Name): PIEDMONT HEALTHCARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E STATESVILLE AVE
MOORESVILLE NC
28115-2598
US

IV. Provider business mailing address

PO BOX 1845
STATESVILLE NC
28687-1845
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-5056
  • Fax: 704-663-5780
Mailing address:
  • Phone: 704-873-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG GUIN
Title or Position: CFO
Credential:
Phone: 704-873-4277