=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033905492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE COMMUNITY CLINIC OF HIGH POINT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 QUAKER LN STE C207
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-841-7154
-----------------------------------------------------
Fax | 336-841-8589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 QUAKER LN STE C207
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-841-7154
-----------------------------------------------------
Fax | 336-841-8589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | MARGARET MCLARTY BUCHANAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-841-7154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------