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General NPI Number Information
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NPI Number | 1346474566
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH SPECIALISTS, PA
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 280 BROAD ST SUITE F
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City | KERNERSVILLE
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State | NC
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Zip | 27284-2796
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Country | US
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Telephone | 336-768-6211
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Fax | 336-768-6869
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Provider Business Mailing Address
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Address Line | 2025 FRONTIS PLAZA BLVD SUITE 200
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5663
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Country | US
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Telephone | 336-768-6211
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Fax | 336-768-6869
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Authorized Official
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Title or Position | CEO
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Name | MRS. JACQUELYN TILLINGER
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Credential | MHA
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Telephone | 336-768-6211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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