Individual
STACEY L. PETERSON-CARMICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-4500
(336) 713-4501
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
01073456
IN
208000000X
Pediatrics Physician
2004-00573
NC
2080P0203X
Pediatric Critical Care Medicine Physician
01073456
IN
2080P0214X
Pediatric Pulmonology Physician
01073456
IN
2080P0214X
Pediatric Pulmonology Physician
Primary
2004-00573
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201216170
—
IN
Enumeration date
05/14/2007
Last updated
06/05/2026
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