Organization
PIEDMONT GASTROENTEROLOGY SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE L WALLACE CMPE (PRACTICE ADMINISTRATOR)
(336) 714-3544
Entity
Organization
Contact information
Practice address
1901 S HAWTHORNE RD, SUITE 310, WINSTON SALEM, NC 27103-3921
(336) 760-4340
(336) 765-2869
Mailing address
1901 S HAWTHORNE RD, SUITE 310, WINSTON SALEM, NC 27103-3921
(336) 760-4340
(336) 765-2869
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901548
—
NC
Enumeration date
09/25/2006
Last updated
10/12/2012
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