Individual
HENRY TERRELL MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1830 S HAWTHORNE ROAD, WINSTON-SALEM, NC 27103-4047
(336) 448-2427
(336) 765-2869
Mailing address
1830 S HAWTHORNE ROAD, WINSTON-SALEM, NC 27103-4047
(336) 448-2427
(336) 765-2869
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
34106
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2900766
UNITED HEALTHCARE
—
01
—
59816
BLUE CROSS BLUE SHIELD
—
05
—
89-59816
—
NC
Enumeration date
08/18/2006
Last updated
12/14/2020
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