Provider Demographics
NPI:1841914561
Name:CLINIC ON THE CORNER, PLLC
Entity type:Organization
Organization Name:CLINIC ON THE CORNER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACRICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING SPECIA
Authorized Official - Phone:702-326-6749
Mailing Address - Street 1:3918 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-299-0057
Mailing Address - Fax:252-673-2518
Practice Address - Street 1:3918 BISHOP RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2780
Practice Address - Country:US
Practice Address - Phone:252-299-0057
Practice Address - Fax:252-673-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty