Organization
TIMA WELLNESS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BYRON GLADDEN (PRACTICE MANAGER)
(336) 907-3006
Entity
Organization
Contact information
Practice address
1591 YANCEYVILLE STREET, SUITE 200A, GREENSBORO, NC 27405-6941
(336) 907-3006
(336) 663-8421
Mailing address
1591 YANCEYVILLE STREET, SUITE 200A, GREENSBORO, NC 27405-6941
(336) 907-3006
(336) 230-1761
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
95-01417
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8975633
—
NC
Enumeration date
03/25/2015
Last updated
11/30/2017
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