Provider Demographics
NPI:1962658237
Name:GENERATIONS FAMILY MEDICINE
Entity type:Organization
Organization Name:GENERATIONS FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMOM OFFICE MGT.
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:910-653-6610
Mailing Address - Street 1:106 TABOR CROSSING
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463
Mailing Address - Country:US
Mailing Address - Phone:910-653-6610
Mailing Address - Fax:910-653-6606
Practice Address - Street 1:106 TABOR CROSSING
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463
Practice Address - Country:US
Practice Address - Phone:910-653-6610
Practice Address - Fax:910-653-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200801162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909978Medicaid
NC5909978Medicaid