Individual
MRS. GRACE AUTON TEASDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
0010-08201
NC
363A00000X
Physician Assistant
Primary
0010-08201
NC
Other
Enumeration date
07/10/2018
Last updated
03/10/2023
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