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1471 Jag Branch Blvd Ste 103 Kernersville NC 27284-6956 | |
(336) 515-7410 | |
(336) 515-7419 |
Full Name | |
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Speciality | Family Medicine |
Location | 1471 Jag Branch Blvd Ste 103, 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 60447 Charlotte NC 28260-0447 Ph: () - | 1471 Jag Branch Blvd Ste 103 Kernersville NC 27284-6956 Ph: (336) 515-7410 |
NPI Number | 1730630377 |
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Provider Enumeration Date | 10/19/2016 |
Last Update Date | 07/09/2024 |
Identifier | Type | State | Issuer |
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1730630377 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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