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291 Broad St Kernersville NC 27284-2932 | |
(336) 993-8181 | |
(336) 996-9539 |
Full Name | |
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Speciality | Family Medicine |
Location | 291 Broad St, Kernersville, North Carolina |
Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
Authorized Official Contact | 7043166081 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 751803 Charlotte NC 28260-2362 Ph: (336) 993-8181 | 291 Broad St Kernersville NC 27284-2932 Ph: (336) 993-8181 |
NPI Number | 1679531495 |
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Provider Enumeration Date | 05/02/2006 |
Last Update Date | 07/11/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679531495 | NPI | - | NPPES |
CA1315 | Other | NC | RAILROAD MEDICARE |
7901969 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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