Organization
ASHLEYBROOK CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THAI T PHAN MD (PRESIDENT)
(336) 659-9045
Entity
Organization
Contact information
Practice address
1321 ASHLEYBROOK LANE, WINSTON SALEM, NC 27103-2918
(336) 659-9045
(336) 659-7866
Mailing address
1321 ASHLEYBROOK LANE, WINSTON SALEM, NC 27103-2918
(336) 659-9045
(336) 659-7866
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
28930
NC
2084P0800X
Psychiatry Physician
28930
NC
208VP0000X
Pain Medicine Physician
28930
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152F
BCBS
NC
Enumeration date
01/18/2007
Last updated
08/01/2008
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