Healthcare Provider Details

I. General information

NPI: 1861859654
Provider Name (Legal Business Name): JAMIE KNOX EADS H.I.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 ASHLEYBROOK LN
WINSTON SALEM NC
27103-2918
US

IV. Provider business mailing address

1313 ASHLEYBROOK LN
WINSTON SALEM NC
27103-2918
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-1990
  • Fax: 336-765-1993
Mailing address:
  • Phone: 336-765-1990
  • Fax: 336-765-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: