Provider Information for 1649877929
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MIDGE SPONG
Sex: Female
NPI: 1649877929
Last Updated: 2020-10-08
Certification Date: 2020-10-08
Certification Date: 2020-10-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1649877929 | ||||||||
| Enumeration Date | 2020-10-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1603 REGENTS PARK LN GREENSBORO, NC 27455-0807 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1603 REGENTS PARK LN GREENSBORO, NC 27455-0807 United States Phone: 336-312-6324 | Fax: | ||||||||
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