Healthcare Provider Details

I. General information

NPI: 1114921137
Provider Name (Legal Business Name): FAMILY CARE HEALTH AND WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HSA LN
WINSTON SALEM NC
27101-2048
US

IV. Provider business mailing address

1430 HSA LN
WINSTON SALEM NC
27101-2048
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-9002
  • Fax: 336-722-3780
Mailing address:
  • Phone: 336-723-9002
  • Fax: 336-722-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. SANDRA LEIGH SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-723-9002