Individual
DR. JACQUELINE HEDER MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2927 LYNDHURST AVE, WINSTON-SALEM, NC 27103-4005
(336) 765-9350
(336) 760-4255
Mailing address
2927 LYNDHURST AVE, WINSTON-SALEM, NC 27103-4005
(336) 765-9350
(336) 760-4255
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
9800639
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144Y
BCBS
NC
05
—
891144Y
—
NC
Enumeration date
10/14/2005
Last updated
11/17/2011
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