Healthcare Provider Details

I. General information

NPI: 1811807811
Provider Name (Legal Business Name): RENEW HEALTH AND AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GRAYSON ST STE 3
SPARTA NC
28675-6006
US

IV. Provider business mailing address

40 GRAYSON ST STE 3
SPARTA NC
28675-6006
US

V. Phone/Fax

Practice location:
  • Phone: 336-355-0174
  • Fax:
Mailing address:
  • Phone: 336-355-0174
  • Fax: 336-742-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH COLLINS
Title or Position: OWNER
Credential: FNP-BC
Phone: 336-355-0174