Individual
MARK CHINN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 E LEE AVE, YADKINVILLE, NC 27055-8132
(336) 679-8805
(336) 679-3057
Mailing address
1837 MURPHY LN, WINSTON SALEM, NC 27104-5910
(336) 682-0746
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2005-00966
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900265
—
NC
Enumeration date
01/24/2007
Last updated
05/23/2012
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