Provider Demographics
NPI:1720473002
Name:PIEDMONT FAMILY MEDICINE, OCCUPATIONAL HEALTH AND URGENT CARE, LLC
Entity type:Organization
Organization Name:PIEDMONT FAMILY MEDICINE, OCCUPATIONAL HEALTH AND URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-8999
Mailing Address - Street 1:2337 WINTERHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6792
Mailing Address - Country:US
Mailing Address - Phone:336-760-8999
Mailing Address - Fax:
Practice Address - Street 1:2337 WINTERHAVEN LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6792
Practice Address - Country:US
Practice Address - Phone:336-760-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200312120Medicaid
NC2075333Medicare PIN