Provider Demographics
NPI:1124563531
Name:NORTH CAROLINA INPATIENT MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NORTH CAROLINA INPATIENT MEDICINE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALBOT
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MCCORMICK, III
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-441-8500
Mailing Address - Street 1:5901 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE C-350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5382
Mailing Address - Country:US
Mailing Address - Phone:678-441-8500
Mailing Address - Fax:678-441-8656
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014RMOtherBCBS
NC014RMOtherBCBS