Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jan 6, 2006
License(s)
0000-28452 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 12208 HWY 150 N | Winston-Salem, NC 27127 | 336-764-2324 |
| MAILING | PO BOX 751803 | Charlotte, NC 28275-1803 | 336-764-2324 |
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.