MEDICARE: AUDREY SABRINA GARNEAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	R4070	KY
2	207V00000X	Obstetrics & Gynecology Physician	2020-00649	NC

General Provider Information

NPI Number	:	1285098061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY SABRINA GARNEAU MD

Provider Business Mailing Address
First Line	:	3821 FORRESTGATE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2930
Country	:	US
Telephone Number	:	336-448-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 E 7TH ST STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4397
Country	:	US
Telephone Number	:	980-256-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	07/10/2023

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