Provider Demographics
NPI:1548446693
Name:GREATER HICKORY FAMILY MEDICINE
Entity type:Organization
Organization Name:GREATER HICKORY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-431-4988
Mailing Address - Street 1:2336 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2007
Mailing Address - Country:US
Mailing Address - Phone:828-431-4988
Mailing Address - Fax:828-431-4990
Practice Address - Street 1:2336 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2007
Practice Address - Country:US
Practice Address - Phone:828-431-4988
Practice Address - Fax:828-431-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891320KMedicaid
NC891320KMedicaid
NCG91947Medicare UPIN