Provider Demographics
NPI:1043894504
Name:GENERATIONS FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:GENERATIONS FAMILY PRACTICE, PA
Other - Org Name:TRIAD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-333-2741
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:984-333-2741
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:300 MACK RD STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-1066
Practice Address - Country:US
Practice Address - Phone:336-510-0202
Practice Address - Fax:336-493-4808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS FAMILY PRACTICE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-11
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty