Basic Information
| Provider Information | |||||||||
| NPI: | 1366447807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EUBANKS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365105510 | ||||||||
| FaxNumber: | 3365105515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 WESTCHESTER DR | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 9801642 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1207825 | 01 | NC | UNITED HEALTHCARE | OTHER | 7560128 | 01 | NC | AETNA | OTHER | 87515 | 01 | NC | MEDCOST | OTHER | 132NV | 01 | NC | BLUE CROSS | OTHER | 891178U | 05 | NC | MEDICAID |