Provider Demographics
NPI:1528459310
Name:SILVER MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:SILVER MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-412-5407
Mailing Address - Street 1:8611 CONCORD MILLS BLVD
Mailing Address - Street 2:PMB 460
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1434 PRESTBURY RD NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3570
Practice Address - Country:US
Practice Address - Phone:757-412-5407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006038261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center