Individual
NICOLE MARIE LAWING KOUTLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1372 WESTGATE CENTER DR, WINSTON SALEM, NC 27103-2932
(336) 659-4814
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
2021-01464
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750887915
—
NC
05
—
1750887915
—
VA
01
—
NNS226A
MEDICARE PTAN
NC
Enumeration date
04/04/2018
Last updated
10/31/2023
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