Individual
JASON THOMAS VANNOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3551
(336) 716-4551
Mailing address
791 JONESTOWN RD, WINSTON SALEM, NC 27103-1252
(336) 716-4551
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3036-A
NC
101YM0800X
Mental Health Counselor
A9545
NC
363A00000X
Physician Assistant
Primary
—
NC
Other
Enumeration date
04/05/2012
Last updated
07/11/2019
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