Organization
CLUB HAVEN FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY J HATLEY (PRACTICE MANAGER)
(336) 768-9575
Entity
Organization
Contact information
Practice address
2801 LYNDHURST AVE, WINSTON SALEM, NC 27103-4109
(336) 768-9575
(336) 774-1737
Mailing address
2801 LYNDHURST AVE, WINSTON SALEM, NC 27103-4109
(336) 768-9575
(336) 774-1737
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/01/2010
Last updated
04/30/2015
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