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General NPI Number Information
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NPI Number | 1326016486
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Entity Type | Individual
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Provider Name | GALE LYNN HARKNESS MPH PHD PAC
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1009 MAIN ST STOKES FAMILY HEALTH CENTER
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City | DANBURY
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State | NC
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Zip | 27016-0187
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Country | US
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Telephone | 336-593-2400
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Fax | 336-593-9361
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Provider Business Mailing Address
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Address Line | 1320 PEBBLEBROOK RD
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City | WINSTON SALEM
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State | NC
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Zip | 27105-9619
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Country | US
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Telephone | 336-377-9170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 100127
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License Number State | NC
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