=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144279761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARNE ANN TOWER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 09/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 GOLF HOUSE CT E
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-9296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-449-9848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 N ELM ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-832-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9901058
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------