Basic Information
| Provider Information | |||||||||
| NPI: | 1003558461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 DARRINGTON DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198523999 | ||||||||
| FaxNumber: | 9193789114 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 W MOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272842534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369931618 | ||||||||
| FaxNumber: | 3369935512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2022 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE IMPLEMENTATION MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9843332741 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.