Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Jul 19, 2021
License(s)
5014731 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 935983 | Atlanta, GA 31193-5983 | |
| LOCATION | 1010 BETHESDA CT | Winston Salem, NC 27103-3019 | 336-277-8800 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.