Organization
WILKES ENT& AUDIOLOGY, PLLC
Active
Other names
Mt. Airy ENT-Head & Neck Surgery Audiology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. M BARRY ELLIS MD (OWNER DOCTOR)
(336) 673-3125
Entity
Organization
Contact information
Practice address
708 S SOUTH ST STE 300, MOUNT AIRY, NC 27030-4589
(336) 838-7758
(336) 838-7758
Mailing address
708 S SOUTH ST STE 300, MOUNT AIRY, NC 27030-4589
(336) 673-3125
(336) 838-9790
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890115W
—
NC
01
—
CC6285
RAILROAD MEDICARE
NC
Enumeration date
05/31/2006
Last updated
01/06/2020
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