Individual
WILLIAM BRYAN JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
170 KIMEL PARK DR, WINSTON SALEM, NC 27103
(336) 768-1270
(336) 765-6375
Mailing address
4601 PARK RD STE 250, CHARLOTTE, NC 28209-2373
(704) 323-2000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
200400218
NC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
200400218
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223770001
MEDICARE DME
NC
05
—
1306849047
—
NC
05
—
89136WG
—
NC
Enumeration date
05/26/2005
Last updated
08/13/2020
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