Organization
NOVANT HEALTH CLEMMONS OUTPATIENT SURGERY, LLC
Active
Other names
CRNA PRO FEES
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD OSBORNE GREEN (ADMINISTRATOR ASC)
(336) 277-1782
Entity
Organization
Contact information
Practice address
7210 VILLAGE MEDICAL CIRCEL, STE 235, CLEMMONS, NC 27012
(336) 893-3100
(336) 893-3109
Mailing address
101 N CHERRY ST, STE 600, WINSTON SALEM, NC 27101-4013
(336) 277-1604
(336) 277-9584
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126701
AAAHC
NC
Enumeration date
01/02/2020
Last updated
01/02/2020
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