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General NPI Number Information
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NPI Number | 1215485024
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Entity Type | Organization
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Legal Business Name | PIEDMONT TRIAD REGIONAL COUNCIL
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 1398 CARROLLTON CROSSING DR
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3896
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Country | US
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Telephone | 336-904-0300
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Fax | 336-904-0301
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Provider Business Mailing Address
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Address Line | 1398 CARROLLTON CROSSING DR
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3896
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Country | US
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Telephone | 336-904-0300
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Fax | 336-904-0301
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MATTHEW DOLGE
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Credential |
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Telephone | 336-904-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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