Healthcare Provider Details

I. General information

NPI: 1720025851
Provider Name (Legal Business Name): WILKES ENT& AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S SOUTH ST STE 300
MOUNT AIRY NC
27030-4589
US

IV. Provider business mailing address

708 S SOUTH ST STE 300
MOUNT AIRY NC
27030-4589
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-7758
  • Fax: 336-838-7758
Mailing address:
  • Phone: 336-673-3125
  • Fax: 336-838-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M BARRY ELLIS
Title or Position: OWNER DOCTOR
Credential: MD
Phone: 336-673-3125