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General NPI Number Information
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NPI Number | 1669410783
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Entity Type | Organization
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Legal Business Name | SEAGROVE MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 614 N BROAD ST
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City | SEAGROVE
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State | NC
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Zip | 27341-8613
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Country | US
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Telephone | 336-873-7248
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Fax | 336-873-7238
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Provider Business Mailing Address
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Address Line | 614 N BROAD ST
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City | SEAGROVE
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State | NC
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Zip | 27341-8613
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Country | US
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Telephone | 336-873-7248
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Fax | 336-873-7238
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANJEET KAUR ACHREJA
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Credential | M.D.
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Telephone | 336-873-7248
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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 | 29458
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 63868
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 29458
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License Number State | NC
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