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General NPI Number Information
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NPI Number | 1275884652
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Entity Type | Organization
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Legal Business Name | GREENVILLE HEALTH CARE CENTER, P.A.
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 7439 MAIN ST
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City | BETHEL
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State | NC
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Zip | 27812-7201
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Country | US
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Telephone | 252-758-4455
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Fax | 252-758-6742
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Provider Business Mailing Address
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Address Line | 7439 MAIN ST
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City | BETHEL
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State | NC
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Zip | 27812-7201
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Country | US
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Telephone | 252-758-4455
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Fax | 252-758-6742
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CLIFTON LEE QUINN JR.
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Credential | PA-C
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Telephone | 252-758-4455
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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 | NC
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