Provider Demographics
NPI:1588256754
Name:GENERATIONS FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:GENERATIONS FAMILY PRACTICE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-333-2741
Mailing Address - Street 1:2839 WENDELL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591
Mailing Address - Country:US
Mailing Address - Phone:919-365-7272
Mailing Address - Fax:919-822-0035
Practice Address - Street 1:2839 WENDELL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9319
Practice Address - Country:US
Practice Address - Phone:919-365-7272
Practice Address - Fax:919-822-0035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS FAMILY PRACTICE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty