Organization Name: | KERNODLE CLINIC, INC-ELON |
NPI Number: | 1821385808 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK F MILLER (PRESIDENT) |
Mailing Address: | 908 S Williamson Ave Elon |
State: | NC US |
Postal Code: | 272449280 |
Phone Number: | 3365382314 |
Fax Number: | 3365382390 |
NPI Enumeration Date: | 06/29/2011 |
NPI Last Update Date: | 03/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |