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General NPI Number Information
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NPI Number | 1437954047
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Entity Type | Organization
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Legal Business Name | P & P LEGACY GROUP, LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 275 AZALEA DR
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City | WINSTON SALEM
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State | NC
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Zip | 27105-1789
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Country | US
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Telephone | 336-473-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 275 AZALEA DR
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City | WINSTON SALEM
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State | NC
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Zip | 27105-1789
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Country | US
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Telephone | 336-473-6266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALBERTA YVETTE SQUIRE
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Credential |
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Telephone | 336-970-7809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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