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Organization
WINSTON-SALEM STATE UNIVERSITY
Active
Organization
WINSTON-SALEM STATE UNIVERSITY
Active
Other names
Wellness Ctr. Student Blue
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY PHILADELPHIA PHD. (DIRECTOR)
(336) 750-3274
Entity
Organization
Contact information
Practice address
601 S MARTIN LUTHER KING JR DR, A.H. RAY BLDG RM. 244, WINSTON SALEM, NC 27110-0001
(336) 750-3301
(336) 750-3303
Mailing address
601 S MARTIN LUTHER KING JR DR, A.H. RAY BLDG RM. 244, WINSTON SALEM, NC 27110-0001
(336) 750-3301
(336) 750-3303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261QS1000X
Student Health Clinic/Center
Primary
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000169
—
NC
Enumeration date
01/17/2014
Last updated
01/17/2014
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