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General NPI Number Information
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NPI Number | 1710202429
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Entity Type | Organization
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Legal Business Name | WILKES PHYSICIAN NETWORK, INC.
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1404 WILLOW LN GREENWAY HEALTHCARE
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-3584
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Country | US
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Telephone | 336-667-0335
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Fax | 336-667-4434
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Provider Business Mailing Address
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Address Line | 1404 WILLOW LN GREENWAY HEALTHCARE
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-3584
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Country | US
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Telephone | 336-667-0335
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Fax | 336-667-4434
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Authorized Official
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Title or Position | SR. VP
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Name | FRIEDA M LOWDER
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Credential |
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Telephone | 704-403-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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