Healthcare Provider Details

I. General information

NPI: 1558766501
Provider Name (Legal Business Name): NATIONAL INSTITUTE OF TOXICOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2014
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 N MAIN ST
MOUNT AIRY NC
27030-3747
US

IV. Provider business mailing address

956 N MAIN ST
MOUNT AIRY NC
27030-3747
US

V. Phone/Fax

Practice location:
  • Phone: 336-648-8550
  • Fax: 336-648-8551
Mailing address:
  • Phone: 336-648-8550
  • Fax: 336-648-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36016
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36016
License Number StateNC

VIII. Authorized Official

Name: ERICA LINDSEY COX
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 336-648-8550