Individual
JOHN LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1250 S MARTIN LUTHER KING JR DR, WINSTON SALEM, NC 27107-1370
(336) 750-2597
Mailing address
1250 S MARTIN LUTHER KING JR DR, WINSTON SALEM, NC 27107-1370
(336) 750-2597
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0169
NC
Other
Enumeration date
02/06/2014
Last updated
02/06/2014
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