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General NPI Number Information
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NPI Number | 1013518166
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Entity Type | Organization
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Legal Business Name | PROACTIVE MD NC, PC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1220 COMMERCE ST SW STE J
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City | CONOVER
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State | NC
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Zip | 28613-8257
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Country | US
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Telephone | 828-282-2280
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Fax | 828-282-2278
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Provider Business Mailing Address
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Address Line | 10 CENTIMETERS DR
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City | MAULDIN
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State | SC
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Zip | 29662-3278
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Country | US
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Telephone | 864-501-0751
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | MARK KEMBLE
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Credential | MD
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Telephone | 864-501-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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