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General NPI Number Information
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NPI Number | 1033931019
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Entity Type | Organization
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Legal Business Name | UNCG MINERVA MOBILE HEALTH UNIT
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 1007 WALKER AVE BLDG 525M
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City | GREENSBORO
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State | NC
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Zip | 27412-0001
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Country | US
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Telephone | 336-334-5640
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 WALKER AVE BLDG 525M
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City | GREENSBORO
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State | NC
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Zip | 27403
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Country | US
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Telephone | 336-334-5640
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SPONSORED PROGRAMS
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Name | JOY M DISMUKES
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Credential |
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Telephone | 336-334-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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