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General NPI Number Information
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NPI Number | 1235442286
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Entity Type | Organization
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Legal Business Name | MISSION MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 2695 HENDERSONVILLE RD SUITE 204
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City | ARDEN
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State | NC
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Zip | 28704-8576
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Country | US
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Telephone | 828-687-8647
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 602373
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City | CHARLOTTE
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State | NC
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Zip | 28260-2373
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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 | VP
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Name | JILL HOGGARD GREEN
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Credential |
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Telephone | 828-213-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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