Healthcare Provider Details

I. General information

NPI: 1275073637
Provider Name (Legal Business Name): COUNTY OF PERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 S MADISON BLVD STE A
ROXBORO NC
27573-5485
US

IV. Provider business mailing address

355 S MADISON BLVD STE A
ROXBORO NC
27573-5485
US

V. Phone/Fax

Practice location:
  • Phone: 336-597-2204
  • Fax: 336-597-4804
Mailing address:
  • Phone: 336-597-2204
  • Fax: 336-597-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET OAKLEY CLAYTON
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 336-597-2204