Healthcare Provider Details

I. General information

NPI: 1366821407
Provider Name (Legal Business Name): KIINGS NEUROLOGICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DOLLEY MADISON RD STE 210
GREENSBORO NC
27410-5169
US

IV. Provider business mailing address

445 DOLLEY MADISON RD STE 210
GREENSBORO NC
27410-5169
US

V. Phone/Fax

Practice location:
  • Phone: 336-365-1001
  • Fax: 336-897-1533
Mailing address:
  • Phone: 336-365-1001
  • Fax: 336-897-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2011-00255
License Number StateNC

VIII. Authorized Official

Name: DR. OLUKAYODE OLUSEUN ONASANYA
Title or Position: CEO
Credential: M.D
Phone: 336-365-1001