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Organization
GATE CITY INTEGRATIVE MEDICAL CLINIC, PLLC
Active
Organization
GATE CITY INTEGRATIVE MEDICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA JOHNSON FNP-BC (CHIEF EXECUTIVE OFFICER)
(336) 860-1514
Entity
Organization
Contact information
Practice address
806 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-7076
(336) 860-1514
(320) 238-7190
Mailing address
806 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-7076
(336) 860-1514
(320) 238-7190
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
251E00000X
Home Health Agency
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/10/2019
Last updated
09/19/2019
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