Healthcare Provider Details

I. General information

NPI: 1801114343
Provider Name (Legal Business Name): JOSHUA COLE MCKINNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 VILLAGE MEDICAL CIR
CLEMMONS NC
27012-8004
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-893-2420
  • Fax: 336-893-2431
Mailing address:
  • Phone: 336-718-8383
  • Fax: 336-718-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013-00986
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11015589A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11015589A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2013-00986
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: