Healthcare Provider Details

I. General information

NPI: 1003481979
Provider Name (Legal Business Name): AMRO ALI YASSIN-AWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMR AWAD MD

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PARKWOOD DR
ELKIN NC
28621-2430
US

IV. Provider business mailing address

180 PARKWOOD DR
ELKIN NC
28621-2430
US

V. Phone/Fax

Practice location:
  • Phone: 336-527-7217
  • Fax: 336-716-5438
Mailing address:
  • Phone: 336-527-7217
  • Fax: 336-716-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2024-00477
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.48335
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: