Individual
AMY JO MCMICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4618 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3520
(336) 716-2255
(336) 716-9258
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9258
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9400925
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005320000
—
WV
01
—
4633020
AETNA
—
01
—
57811
BCBS
NC
05
—
5900514
—
VA
01
—
64000
MEDCOST
NC
01
—
6840
PARTNERS
NC
05
—
8957811
—
NC
05
—
Q00930
—
SC
Enumeration date
12/13/2005
Last updated
10/21/2010
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