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General NPI Number Information
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NPI Number | 1477526861
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Entity Type | Organization
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Legal Business Name | NORTHWEST MEDICAL PARTNERS, P.A.
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 280 NORTH POINTE BLVD.
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City | MT. AIRY
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State | NC
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Zip | 27030-2267
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Country | US
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Telephone | 336-786-4133
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Fax | 336-786-4338
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Provider Business Mailing Address
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Address Line | 280 NORTH POINTE BLVD.
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City | MT. AIRY
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State | NC
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Zip | 27030-2267
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Country | US
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Telephone | 336-786-4133
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Fax | 336-786-4338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD N. GARDNER
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Credential | M.D.
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Telephone | 336-786-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L000989
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30025
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License Number State | NC
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