# MEDICAL GROUP OF THE TRIAD, PA

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

## Provider details

- **NPI number:** 1285095034
- **Authorized official:** DR. TIMOTHY KWIATKOWSKI MD (PRESIDENT)
- **Authorized official phone:** (336) 242-1125

## Contact information

- **Practice address:** 215 W US HIGHWAY 64, SUITE 1, LEXINGTON, NC 27295-2567
- **Practice address phone:** (336) 242-1125
- **Mailing address:** 215 W US HIGHWAY 64, SUITE 1, LEXINGTON, NC 27295-2567
- **Mailing address phone:** (336) 242-1125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/08/2016
- **Last updated:** 03/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1285658906 | NPI PERSONAL KRISTI MAULDIN | NC |
| 01 | — | 1396910345 | NPI INDIVIDUAL SHENOA RONDEAU | NC |
| 01 | — | 1689661761 | NPI INDIVIDUAL TIM KWIATKOWSKI | NC |