Healthcare Provider Details

I. General information

NPI: 1437110186
Provider Name (Legal Business Name): JOSEPH CHRISTIAN PARDUE R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KIMEL PARK DR
WINSTON-SALEM NC
27103-6946
US

IV. Provider business mailing address

5260 CAMP BETTY HASTINGS RD
WALKERTOWN NC
27051-9103
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3296
  • Fax: 336-760-5484
Mailing address:
  • Phone: 336-595-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number870940
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: