=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992268759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANA WEI QIAO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 WILLARD DAIRY RD STE 203
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27265-8328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-884-3770
-----------------------------------------------------
Fax | 336-884-3771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 E WENDOVER AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-663-5205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 2023-01329
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------