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General NPI Number Information
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NPI Number | 1417130253
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Entity Type | Organization
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Legal Business Name | MAPLEWOOD PSYCHIATRIC ASSOCIATES, PA
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Dates
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Enumeration Date | 12/16/2007
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2830 MAPLEWOOD AVE SUITE A
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4100
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Country | US
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Telephone | 336-768-2424
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Fax | 336-768-1857
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Provider Business Mailing Address
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Address Line | 2830 MAPLEWOOD AVE SUITE A
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City | WINSTON SALEM
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State | NC
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Zip | 27103-4100
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Country | US
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Telephone | 336-768-2424
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Fax | 336-768-1857
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI JARRAHI
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Credential | M.D.
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Telephone | 336-768-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16722
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License Number State | NC
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