Basic Information
| Provider Information | |||||||||
| NPI: | 1972194868 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROCKY MOUNT FAMILY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 ENGLISH RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278046027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Practice Location | |||||||||
| Address1: | 804 ENGLISH RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278046027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524433133 | ||||||||
| FaxNumber: | 2524436726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2021 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE IMPLEMENTATION MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9843332741 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERATIONS FAMILY PRACTICE, PA | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.