# WINSTON-SALEM STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellness Ctr. Student Blue
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851713374
- **Authorized official:** ANTHONY PHILADELPHIA PHD. (DIRECTOR)
- **Authorized official phone:** (336) 750-3274

## Contact information

- **Practice address:** 601 S MARTIN LUTHER KING JR DR, A.H. RAY BLDG RM. 244, WINSTON SALEM, NC 27110-0001
- **Practice address phone:** (336) 750-3301
- **Practice address fax:** (336) 750-3303
- **Mailing address:** 601 S MARTIN LUTHER KING JR DR, A.H. RAY BLDG RM. 244, WINSTON SALEM, NC 27110-0001
- **Mailing address phone:** (336) 750-3301
- **Mailing address fax:** (336) 750-3303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/17/2014
- **Last updated:** 01/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7000169 | — | NC |