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General NPI Number Information
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NPI Number | 1477546620
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Entity Type | Organization
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Legal Business Name | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER COMMUNITY PHYSICIANS
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 910 WORTH ST FOOTHILLS PRIMARY CARE
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City | MOUNT AIRY
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State | NC
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Zip | 27030-4458
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Country | US
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Telephone | 336-786-5108
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Fax | 336-783-6842
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Provider Business Mailing Address
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Address Line | 910 WORTH ST FOOTHILLS PRIMARY CARE
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City | MOUNT AIRY
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State | NC
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Zip | 27030-4458
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Country | US
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Telephone | 336-786-5108
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Fax | 336-783-6842
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. LEWIS S THORP III
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Credential |
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Telephone | 336-721-3900
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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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