Provider Demographics
NPI:1437259983
Name:PIEDMONT ADULT&GERIATRIC MEDICINE, PLLC
Entity Type:Organization
Organization Name:PIEDMONT ADULT&GERIATRIC MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERZY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOPALA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:336-302-1048
Mailing Address - Street 1:2108 SAN FERNANDO DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9643
Mailing Address - Country:US
Mailing Address - Phone:336-885-3058
Mailing Address - Fax:336-885-3058
Practice Address - Street 1:2108 SAN FERNANDO DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9643
Practice Address - Country:US
Practice Address - Phone:336-885-3058
Practice Address - Fax:336-885-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty