Healthcare Provider Details

I. General information

NPI: 1437737798
Provider Name (Legal Business Name): BRIAN ANDREW GOTTWALT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 WILLARD DAIRY RD STE 203
HIGH POINT NC
27265-8328
US

IV. Provider business mailing address

1920 W 1ST ST FL 3
WINSTON SALEM NC
27104-4220
US

V. Phone/Fax

Practice location:
  • Phone: 336-884-3770
  • Fax: 336-884-3771
Mailing address:
  • Phone: 336-716-4479
  • Fax: 336-716-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024-01947
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2024-01947
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: