Provider Demographics
NPI:1053803601
Name:HINES, GENESIS (MD)
Entity type:Individual
Prefix:DR
First Name:GENESIS
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1470
Mailing Address - Country:US
Mailing Address - Phone:252-443-5941
Mailing Address - Fax:
Practice Address - Street 1:719 GREEN VALLEY RD STE 305
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7026
Practice Address - Country:US
Practice Address - Phone:336-275-5391
Practice Address - Fax:336-275-4702
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310899207V00000X
PAMT215153390200000X
NC2022-01690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty