Healthcare Provider Details

I. General information

NPI: 1932203122
Provider Name (Legal Business Name): NORTHERN GREENBRIER HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 9 SINKING CREEK RD
WILLIAMSBURG WV
24991-0010
US

IV. Provider business mailing address

PO BOX 10
WILLIAMSBURG WV
24991-0010
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7872
  • Fax: 304-645-7873
Mailing address:
  • Phone: 304-645-7872
  • Fax: 304-645-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG CURRY
Title or Position: CEO
Credential:
Phone: 304-645-7872