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Organization
WARREN STACKS MD
Active
Organization
WARREN STACKS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARREN STACKS MD (OWNER)
(336) 659-9440
Entity
Organization
Contact information
Practice address
1400 WESTGATE CENTER DR STE 140, WINSTON SALEM, NC 27103-3104
(336) 659-9440
(336) 659-9845
Mailing address
PO BOX 30249, WINSTON SALEM, NC 27130-0249
(336) 659-9440
(336) 659-9845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9401498
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79116
BCBS
NC
05
—
8979116
—
NC
Enumeration date
03/12/2008
Last updated
04/08/2010
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