Individual
BRIAN SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27103
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2019-00729
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2016
Last updated
08/26/2019
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