Organization
PIEDMONT TRIAD REGIONAL COUNCIL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW DOLGE (EXECUTIVE DIRECTOR)
(336) 904-0300
Entity
Organization
Contact information
Practice address
1398 CARROLLTON CROSSING DR, KERNERSVILLE, NC 27284-3896
(336) 904-0300
(336) 904-0301
Mailing address
1398 CARROLLTON CROSSING DR, KERNERSVILLE, NC 27284-3896
(336) 904-0300
(336) 904-0301
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
12/12/2018
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