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General NPI Number Information
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NPI Number | 1740305101
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Entity Type | Individual
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Provider Name | GEORGE DAVID EDENFIELD SR. PAC
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 4431 US HIGHWAY 220 N
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City | SUMMERFIELD
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State | NC
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Zip | 27358-9411
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Country | US
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Telephone | 336-643-7711
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Fax | 336-643-3047
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Provider Business Mailing Address
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Address Line | 1701 WESTCHESTER DR STE 850
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City | HIGH POINT
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State | NC
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Zip | 27262-7008
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Country | US
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Telephone | 336-802-2400
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Fax | 336-802-2534
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101537
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License Number State | NC
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