Provider Demographics
NPI:1154332971
Name:EVERGREEN HEALTH PROMOTION,P.A.
Entity type:Organization
Organization Name:EVERGREEN HEALTH PROMOTION,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-659-0020
Mailing Address - Street 1:1365 WESTGATE CENTER DR
Mailing Address - Street 2:STE G1
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-659-6250
Mailing Address - Fax:336-659-6239
Practice Address - Street 1:1365 WESTGATE CENTER DR
Practice Address - Street 2:STE G1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-659-6250
Practice Address - Fax:336-659-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8916312Medicaid
C82850Medicare UPIN
NC2163738Medicare ID - Type Unspecified