MEDICARE: JOHN J. MCKINNEY JR. DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	31735	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110210894	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780602185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J. MCKINNEY JR. DO

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-713-0947
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 NATIONAL HWY STE 100
Second Line	:
City	:	THOMASVILLE
State	:	NC
Zip	:	27360-2668
Country	:	US
Telephone Number	:	336-475-2000
Fax Number	:	336-475-2008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/28/2020

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Directions to “ JOHN J. MCKINNEY JR. DO” Practice Location

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