Healthcare Provider Details

I. General information

NPI: 1720294127
Provider Name (Legal Business Name): TASHA BARNETT DIAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA DENEE BARNETT MD

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR SUITE 203
HIGH POINT NC
27265-8357
US

IV. Provider business mailing address

1701 WESTCHESTER DRIVE SUITE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2200
  • Fax: 336-802-2201
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT184699
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5908185
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: