Healthcare Provider Details

I. General information

NPI: 1982661690
Provider Name (Legal Business Name): PIEDMONT COMMUNITY PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 HEALY DR
WINSTON SALEM NC
27103-1404
US

IV. Provider business mailing address

PO BOX 26822
WINSTON SALEM NC
27114-6822
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3530
  • Fax: 336-768-3636
Mailing address:
  • Phone: 336-765-0187
  • Fax: 336-768-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA CAPPS MOODY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 336-768-3530