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General NPI Number Information
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NPI Number | 1902892086
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Entity Type | Individual
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Provider Name | GWENDOLYN MARY WIGAND BOLLING MD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 1381 WESTGATE CENTER DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-2934
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Country | US
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Telephone | 336-718-0100
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Fax | 336-718-0120
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Provider Business Mailing Address
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Address Line | PO BOX 751803
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City | CHARLOTTE
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State | NC
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Zip | 28275-1803
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Country | US
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Telephone | 336-718-0100
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Fax | 336-718-0120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000001333
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2000001333
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License Number State | NC
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