Healthcare Provider Details

I. General information

NPI: 1114368560
Provider Name (Legal Business Name): PIEDMONT OCCUPATIONAL & GENERAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 TURNER DR STE A
REIDSVILLE NC
27320-5754
US

IV. Provider business mailing address

217 TURNER DR STE A
REIDSVILLE NC
27320-5754
US

V. Phone/Fax

Practice location:
  • Phone: 336-349-4070
  • Fax:
Mailing address:
  • Phone: 336-349-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9400512
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number9400512
License Number StateNC

VIII. Authorized Official

Name: MELISSA D PRUITT
Title or Position: OWNER
Credential: M.D.
Phone: 336-453-3446