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Organization
PIEDMONT COMMUNITY PHYSICIANS PC
Active
Organization
PIEDMONT COMMUNITY PHYSICIANS PC
Active
Parent organization
PIEDMONT COMMUNITY PHYSICIANS, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PIEDMONT COMMUNITY PHYSICIANS, PC
Authorized official
MR. DICKSON M CAPPS (CAO)
(336) 765-0187
Entity
Organization
Contact information
Practice address
3610 DARREN RD, CLEMMONS, NC 27012-9077
(336) 765-0185
(336) 768-3636
Mailing address
PO BOX 26822, WINSTON SALEM, NC 27114-6822
(336) 765-0185
(336) 768-3636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2002-01010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2325473A
MEDICARE PTAN
NC
01
—
7066710
AETNA
—
Enumeration date
04/26/2007
Last updated
01/04/2018
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