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General NPI Number Information
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NPI Number | 1104124155
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Entity Type | Organization
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Legal Business Name | GREENSBORO FAMILY MEDICINE PA
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 104 W NORTHWOOD ST SUITE A
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City | GREENSBORO
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State | NC
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Zip | 27401-1326
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Country | US
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Telephone | 336-790-0519
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Fax | 336-691-8977
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Provider Business Mailing Address
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Address Line | 104 W NORTHWOOD ST SUITE A
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City | GREENSBORO
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State | NC
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Zip | 27401-1326
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Country | US
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Telephone | 336-790-0519
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Fax | 336-691-8977
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. JOHN JOSEPH DEWAR SR.
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Credential | PA-C
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Telephone | 336-790-0519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001000092
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 200600668
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License Number State | NC
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