Healthcare Provider Details

I. General information

NPI: 1205062551
Provider Name (Legal Business Name): COUNTY OF ANSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E ASHE ST
WADESBORO NC
28170-2702
US

IV. Provider business mailing address

110 E ASHE ST P. O BOX 473
WADESBORO NC
28170-2702
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-5188
  • Fax: 704-694-9067
Mailing address:
  • Phone: 704-694-5188
  • Fax: 704-694-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA ANN CLARK
Title or Position: PROCESSING ASST V
Credential:
Phone: 704-694-5188