Organization
GENESIS MEDICAL PRACTICE, PLLC
Active
Organization
GENESIS MEDICAL PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN SHACKLEFORD MD (OWNER)
(919) 370-8188
Entity
Organization
Contact information
Practice address
1921 NEW GARDEN RD, GREENSBORO, NC 27410-2193
(919) 370-8188
Mailing address
1921 NEW GARDEN RD APT I104, GREENSBORO, NC 27410-2200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7154047
UNITED HEALTHCARE
—
Enumeration date
09/10/2024
Last updated
09/10/2024
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