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General NPI Number Information
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NPI Number | 1356953335
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Entity Type | Organization
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Legal Business Name | TRIAD REGENERATIVE MEDICINE, PC
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 1309 LEES CHAPEL RD
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City | GREENSBORO
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State | NC
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Zip | 27455-2601
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Country | US
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Telephone | 336-285-7077
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Fax | 336-285-7078
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Provider Business Mailing Address
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Address Line | PO BOX 4365
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City | GREENSBORO
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State | NC
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Zip | 27404-4365
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Country | US
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Telephone | 336-285-7077
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Fax | 336-285-7078
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Authorized Official
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Title or Position | CLINIC FACILITATOR
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Name | DR. DARCY MARIE WARD
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Credential | DC
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Telephone | 336-285-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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