Healthcare Provider Details

I. General information

NPI: 1598872269
Provider Name (Legal Business Name): BROOKVIEW WOMENS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD SUITE 105
WINSTON SALEM NC
27103-5661
US

IV. Provider business mailing address

3333 BROOKVIEW HILLS BLVD SUITE 105
WINSTON SALEM NC
27103-5661
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-1464
  • Fax: 336-760-2492
Mailing address:
  • Phone: 336-765-1464
  • Fax: 336-760-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. DONALD EDWARD PITTAWAY SR.
Title or Position: OWNER
Credential: M.D.
Phone: 336-765-1464