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390 W Salem Ave Winston Salem NC 27101-5861 | |
| (336) 721-2375 | |
| (336) 721-2394 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 390 W Salem Ave, Winston Salem, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: () - | 390 W Salem Ave Winston Salem NC 27101-5861 Ph: (336) 721-2375 |
| NPI Number | 1073076956 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073076956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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