Healthcare Provider Details

I. General information

NPI: 1821052481
Provider Name (Legal Business Name): VANESSA P HAYGOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NORTHLINE AVE SUITE 130
GREENSBORO NC
27408-7616
US

IV. Provider business mailing address

3200 NORTHLINE AVE SUITE 130
GREENSBORO NC
27408-7616
US

V. Phone/Fax

Practice location:
  • Phone: 336-286-6565
  • Fax: 336-286-6566
Mailing address:
  • Phone: 336-286-6565
  • Fax: 336-286-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: