Organization
GENUWINEPERSONALCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUDREY JEAN WILLIAMS (OWNER)
(336) 499-7113
Entity
Organization
Contact information
Practice address
3305 STOCKTON ST, WINSTON SALEM, NC 27127-5135
(336) 499-7113
(336) 650-1057
Mailing address
3305 STOCKTON ST, WINSTON SALEM, NC 27127-5135
(336) 499-7113
(336) 650-1057
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408562
—
NC
05
—
8301526
—
NC
05
—
8301733
—
NC
Enumeration date
01/29/2007
Last updated
07/16/2009
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