Healthcare Provider Details

I. General information

NPI: 1124568688
Provider Name (Legal Business Name): NORTHERN HOSPTIAL OF SURRY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N POINTE BLVD
MOUNT AIRY NC
27030-2266
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-789-6267
  • Fax: 336-786-4245
Mailing address:
  • Phone: 336-783-8911
  • Fax: 336-719-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RACHEL HIATT
Title or Position: DIRECTOR CENTRAL BILLING
Credential:
Phone: 336-783-8452