Healthcare Provider Details

I. General information

NPI: 1669011565
Provider Name (Legal Business Name): KAIROS MEDICAL CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BETHESDA PL STE 104
WINSTON SALEM NC
27103-3323
US

IV. Provider business mailing address

3000 BETHESDA PL STE 104
WINSTON SALEM NC
27103-3323
US

V. Phone/Fax

Practice location:
  • Phone: 336-293-4107
  • Fax: 949-577-4324
Mailing address:
  • Phone: 336-293-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES DUNHAM
Title or Position: CO-OWNER
Credential: MD
Phone: 336-909-5939