Healthcare Provider Details

I. General information

NPI: 1265365084
Provider Name (Legal Business Name): EMILY DEE JOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3796 VEST MILL RD
WINSTON SALEM NC
27103-2912
US

IV. Provider business mailing address

5335 ROBINHOOD VILLAGE DR
WINSTON SALEM NC
27106-9820
US

V. Phone/Fax

Practice location:
  • Phone: 336-837-4797
  • Fax: 336-376-7711
Mailing address:
  • Phone: 336-837-4797
  • Fax: 336-376-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30004960
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: