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General NPI Number Information
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NPI Number | 1972915510
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Entity Type | Organization
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Legal Business Name | PIEDMONT COMMUNITY PHYSICIANS PC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 3318 HEALY DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1404
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Country | US
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Telephone | 336-768-3530
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Fax | 336-768-3636
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Provider Business Mailing Address
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Address Line | 3318 HEALY DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1404
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Country | US
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Telephone | 336-768-3530
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Fax | 336-768-3636
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DANA CAPPS MOODY
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Credential |
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Telephone | 336-768-3530
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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 | 2002-01010
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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