Healthcare Provider Details

I. General information

NPI: 1346224599
Provider Name (Legal Business Name): DAHARI D BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NORTHLINE AVE STE 200
GREENSBORO NC
27408-7616
US

IV. Provider business mailing address

3200 NORTHLINE AVE STE 200
GREENSBORO NC
27408-7602
US

V. Phone/Fax

Practice location:
  • Phone: 336-545-5000
  • Fax: 336-545-5020
Mailing address:
  • Phone: 336-545-5000
  • Fax: 336-545-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2008-00414
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2008-00414
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: