Healthcare Provider Details

I. General information

NPI: 1306117627
Provider Name (Legal Business Name): CALLIE GRIFFIN STEGALL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

IV. Provider business mailing address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 336-251-1114
  • Fax: 336-251-1117
Mailing address:
  • Phone: 336-251-1114
  • Fax: 336-251-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1003334
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001003334
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: