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General NPI Number Information
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NPI Number | 1962658237
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Entity Type | Organization
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Legal Business Name | GENERATIONS FAMILY MEDICINE
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 106 TABOR CROSSING
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City | TABOR CITY
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State | NC
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Zip | 28463
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Country | US
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Telephone | 910-653-6610
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Fax | 910-653-6606
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Provider Business Mailing Address
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Address Line | 106 TABOR CROSSING
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City | TABOR CITY
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State | NC
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Zip | 28463
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Country | US
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Telephone | 910-653-6610
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Fax | 910-653-6606
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Authorized Official
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Title or Position | CMOM OFFICE MGT.
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Name | ROBYN L REED
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Credential | CMOM
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Telephone | 910-653-6610
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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 | 200801162
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License Number State | NC
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