Individual
DR. JESSICA AMELIA TATE
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
(336) 716-2801
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 716-2801
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2012-01535
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5921339
—
NC
Enumeration date
06/25/2008
Last updated
12/19/2012
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