Healthcare Provider Details

I. General information

NPI: 1558492439
Provider Name (Legal Business Name): PIEDMONT HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN STREET
PROSPECT HILL NC
27314
US

IV. Provider business mailing address

322 MAIN STREET
PROSPECT HILL NC
27314
US

V. Phone/Fax

Practice location:
  • Phone: 336-562-5972
  • Fax: 336-562-3223
Mailing address:
  • Phone: 336-562-5972
  • Fax: 336-562-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number02997
License Number StateNC

VIII. Authorized Official

Name: LYDIA F. MASON
Title or Position: CFO
Credential:
Phone: 919-933-8494