Individual
GAVIN DOUGLAS BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
1540 LEWISBURG POINTE DR, CLEMMONS, NC 27012-8391
(775) 771-5699
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
263673
TN
Other
Enumeration date
04/29/2025
Last updated
04/29/2025
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