Healthcare Provider Details

I. General information

NPI: 1770938235
Provider Name (Legal Business Name): AUSTIN COLE SKAKLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 HENRY ST
GREENSBORO NC
27405-3669
US

IV. Provider business mailing address

MEDICAL CENTER BLVD WATLINGTON HL FL 3
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-8911
  • Fax:
Mailing address:
  • Phone: 336-716-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020-02660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: