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1933 Jake Alexander Blvd W Ste 103 Salisbury NC 28147-1157 | |
(704) 604-0377 | |
(800) 697-5650 |
Full Name | |
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Speciality | Family Medicine |
Location | 1933 Jake Alexander Blvd W Ste 103, Salisbury, North Carolina |
Authorized Official Name and Position | Adelle R Anthony-williams (OWNER, AUTHORIZED OFFICIAL) |
Authorized Official Contact | 7046040377 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1933 Jake Alexander Blvd W Ste 103 Salisbury NC 28147-1157 Ph: (704) 604-0377 | 1933 Jake Alexander Blvd W Ste 103 Salisbury NC 28147-1157 Ph: (704) 604-0377 |
NPI Number | 1104600923 |
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Provider Enumeration Date | 08/22/2023 |
Last Update Date | 06/10/2024 |
Medicare PECOS PAC ID | 2567818362 |
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Medicare Enrollment ID | O20231031002076 |
Identifier | Type | State | Issuer |
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1104600923 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
Provider Name | Adelle R Anthony Williams |
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Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1073681201 PECOS PAC ID: 4789831959 Enrollment ID: I20120822000507 |
Provider Name | Brittany L Jordan |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770258048 PECOS PAC ID: 1759731698 Enrollment ID: I20231219001348 |
Copperfield Medical Center, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Mocksville Ave, Salisbury, NC 28144 Phone: 704-633-7220 Fax: 704-647-0515 | |