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One Trade Street Granite Falls NC 28630-1525 | |
(828) 396-3136 | |
(828) 396-3105 |
Full Name | |
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Speciality | Family Medicine |
Location | One Trade Street, Granite Falls, North Carolina |
Authorized Official Name and Position | Russell Mars Howerton (SR VP NETWORK PHYS & HS CMO) |
Authorized Official Contact | 3367161331 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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100 Kimel Forest Dr Winston Salem NC 27103-6074 Ph: (336) 716-1331 | One Trade Street Granite Falls NC 28630-1525 Ph: (828) 396-3136 |
NPI Number | 1770858938 |
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Provider Enumeration Date | 03/20/2012 |
Last Update Date | 11/29/2023 |
Identifier | Type | State | Issuer |
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1770858938 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |