Provider Demographics
NPI:1720794944
Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type:Organization
Organization Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Other - Org Name:EAGLE PHYSICIANS WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF EAGLE BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-6515
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-6515
Mailing Address - Fax:336-275-0812
Practice Address - Street 1:5921 W FRIENDLY AVE STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3268
Practice Address - Country:US
Practice Address - Phone:336-268-4100
Practice Address - Fax:336-268-3158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHYSICIANS AND ASSOCIATES P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-31
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty