# GATE CITY INTEGRATIVE MEDICAL CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164071262
- **Authorized official:** ANGELA JOHNSON FNP-BC (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (336) 860-1514

## Contact information

- **Practice address:** 806 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-7076
- **Practice address phone:** (336) 860-1514
- **Practice address fax:** (320) 238-7190
- **Mailing address:** 806 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-7076
- **Mailing address phone:** (336) 860-1514
- **Mailing address fax:** (320) 238-7190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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