Graduated: 2022
NPI: 1124761689
Practice Locations (2)
VIDANT MEDICAL GROUP LLC
2325 STANTONSBURG RD
GREENVILLE, NC 278347534
9197314048
PROACTIVE THERAPY OF NORTH CAROLINA INC
2303 WELLINGTON DR SW, SUITE B
WILSON, NC 278938620
2522436818
Source: CMS National Downloadable File, September 2026.