MEDICARE: MONOGRAM HEALTH PROFESSIONAL SERVICES OF NORTH CAROLINA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TB0200X	Cognitive & Behavioral Psychologist
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
3	207RP1001X	Pulmonary Disease Physician
4	2084P0800X	Psychiatry Physician
5	208D00000X	General Practice Physician
6	363A00000X	Physician Assistant
7	363L00000X	Nurse Practitioner
8	363LF0000X	Family Nurse Practitioner
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
10	174400000X	Specialist
11	1835C0206X	Cardiology Pharmacist
12	207Q00000X	Family Medicine Physician
13	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician
14	207RC0000X	Cardiovascular Disease Physician
15	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1366162885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONOGRAM HEALTH PROFESSIONAL SERVICES OF NORTH CAROLINA PC

Provider Business Mailing Address
First Line	:	5410 MARYLAND WAY STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-8087
Country	:	US
Telephone Number	:	615-465-8684
Fax Number	:	629-240-6003

Provider Business Practice Location Address
First Line	:	615 SAINT GEORGE SQUARE CT STE 300
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1368
Country	:	US
Telephone Number	:	615-673-4455
Fax Number	:	615-432-4651

Authorized Official
Title or Position	:	SECRETARY
Name	:	SHAWN L VERNER
Credential	:
Telephone Number	:	615-994-1889

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	01/29/2025

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