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General NPI Number Information
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NPI Number | 1417620527
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Entity Type | Organization
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Legal Business Name | KAIROS WELLNESS INITIATIVE
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3000 BETHESDA PL STE 202
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3324
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Country | US
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Telephone | 336-293-4107
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Fax | 949-577-4324
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Provider Business Mailing Address
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Address Line | 3000 BETHESDA PL STE 104
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3323
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Country | US
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Telephone | 336-293-4107
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Fax | 949-577-4324
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Authorized Official
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Title or Position | OWNER
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Name | OBINNA IKWECHEGH
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Credential | MD
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Telephone | 336-293-4107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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