Healthcare Provider Details

I. General information

NPI: 1043772460
Provider Name (Legal Business Name): DANA W. BROOKS III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4400
  • Fax: 336-832-4440
Mailing address:
  • Phone: 910-343-7000
  • Fax: 910-667-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number251163
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-01026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: