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General NPI Number Information
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NPI Number | 1194233403
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Entity Type | Organization
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Legal Business Name | FUTUREMED EVENING CLINIC PLLC
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Dates
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Enumeration Date | 01/21/2018
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Last Update Date | 11/26/2020
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Provider Practice Location Address
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Address Line | 2003 BOULEVARD ST STE C
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City | GREENSBORO
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State | NC
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Zip | 27407-4579
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Country | US
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Telephone | 336-579-8328
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 788
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City | GREENSBORO
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State | NC
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Zip | 27402-0788
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TARSHIA DONNELL
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Credential |
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Telephone | 336-523-2305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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