Organization
GAA CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAROLD DEAN GREEN (MEMBER / MANAGER)
(336) 389-3889
Entity
Organization
Contact information
Practice address
4009 W WENDOVER AVE, GREENSBORO, NC 27407-1904
(336) 389-3889
(336) 851-1418
Mailing address
4009 W WENDOVER AVE, GREENSBORO, NC 27407-1904
(336) 389-3889
(336) 851-1418
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
200300814
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40091940
CLINIC
NC
Enumeration date
03/22/2017
Last updated
03/22/2017
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