Healthcare Provider Details

I. General information

NPI: 1144857574
Provider Name (Legal Business Name): JANCARLA MARIE OCAMPO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 LEWISVILLE-CLEMMONS ROAD 3RD FLOOR
CLEMMONS NC
27012-8905
US

IV. Provider business mailing address

100 KIMEL FOREST DRIVE
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-8900
  • Fax: 336-702-9286
Mailing address:
  • Phone: 336-713-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016001
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: