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General NPI Number Information
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NPI Number | 1114368560
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Entity Type | Organization
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Legal Business Name | PIEDMONT OCCUPATIONAL & GENERAL MEDICINE
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 217 TURNER DR STE A
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City | REIDSVILLE
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State | NC
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Zip | 27320-5754
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Country | US
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Telephone | 336-349-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 217 TURNER DR STE A
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City | REIDSVILLE
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State | NC
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Zip | 27320-5754
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Country | US
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Telephone | 336-349-4070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA D PRUITT
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Credential | M.D.
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Telephone | 336-453-3446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 9400512
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 9400512
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License Number State | NC
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