Healthcare Provider Details

I. General information

NPI: 1053241174
Provider Name (Legal Business Name): MR. JOHN WAYNE ZIMMERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MONTEITH DR
CHAPEL HILL NC
27516-4262
US

IV. Provider business mailing address

95 MONTEITH DR
CHAPEL HILL NC
27516-4262
US

V. Phone/Fax

Practice location:
  • Phone: 630-618-6105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: