| Genesis Medical Practice, PLLC | |
|
1921 New Garden Rd Greensboro NC 27410-2193 | |
| (919) 370-8188 | |
| Not Available |
| Full Name | Genesis Medical Practice, PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1921 New Garden Rd, Greensboro, North Carolina |
| Authorized Official Name and Position | Brian Shackleford (OWNER) |
| Authorized Official Contact | 9193708188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Medical Practice, PLLC 1921 New Garden Rd Apt I104 Greensboro NC 27410-2200 | Genesis Medical Practice, PLLC 1921 New Garden Rd Greensboro NC 27410-2193 Ph: (919) 370-8188 |
| NPI Number | 1205662004 |
|---|---|
| Provider Enumeration Date | 09/10/2024 |
| Last Update Date | 09/10/2024 |
| Certification Date | 09/10/2024 |
| Medicare PECOS PAC ID | 4688195258 |
|---|---|
| Medicare Enrollment ID | O20250311003917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205662004 | NPI | - | NPPES |
| 7154047 | Other | UNITED HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Brian Alexander Shackleford |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154777662 PECOS PAC ID: 8426341819 Enrollment ID: I20190618000120 |
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