Healthcare Provider Details

I. General information

NPI: 1659917615
Provider Name (Legal Business Name): OURHEALTH PROFESSIONAL PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 S STRATFORD RD BLDG 1
WINSTON SALEM NC
27103-6225
US

IV. Provider business mailing address

20 WINOOSKI FALLS WAY
WINOOSKI VT
05404-2228
US

V. Phone/Fax

Practice location:
  • Phone: 336-257-1775
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRY LAYMAN
Title or Position: OWNER
Credential: MD
Phone: 866-434-3255