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NPI Code Detail

MEDICARE: GEORGE DAVID EDENFIELD SR. PAC

MEDICARE: GEORGE DAVID EDENFIELD SR. PAC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant101537NC

General Provider Information

NPI Number : 1740305101
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE DAVID EDENFIELD SR. PAC
Provider Business Mailing Address
First Line : 1701 WESTCHESTER DR
Second Line : STE 850
City : HIGH POINT
State : NC
Zip : 27262-7008
Country : US
Telephone Number : 336-802-2400
Fax Number : 336-802-2534
Provider Business Practice Location Address
First Line : 4431 US HIGHWAY 220 N
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-9411
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 09/14/2015

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Directions to “ GEORGE DAVID EDENFIELD SR. PAC” Practice Location

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