Organization
JONATHON G. DEWALD, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHON G DEWALD M.D. (OWNER)
(252) 243-7542
Entity
Organization
Contact information
Practice address
2605 FOREST HILLS RD SW STE B, WILSON, NC 27893-4448
(252) 243-7542
Mailing address
PO BOX 3585, WILSON, NC 27895-3585
(252) 243-7542
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28169
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C83523
UPIN
NC
Enumeration date
02/20/2008
Last updated
02/20/2008
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