Healthcare Provider Details

I. General information

NPI: 1023098126
Provider Name (Legal Business Name): MEREDITH GORDON CLIFTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 03/07/2023
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 WESTGATE CENTER DR
WINSTON-SALEM NC
27103-2934
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0001-02393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: