Individual
TAMISON JEWETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
34637
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001736000
—
WV
01
—
2710
PARTNERS
NC
01
—
4509049
AETNA
—
01
—
45946
BCBS
NC
01
—
55928
MEDCOST
NC
05
—
6713033
—
VA
05
—
8945946
—
NC
05
—
Q34638
—
SC
Enumeration date
12/02/2005
Last updated
05/09/2008
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