Individual
JATAYA ALIANNA FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4150 OLD LEXINGTON RD, WINSTON SALEM, NC 27107-6822
(336) 843-0282
Mailing address
4150 OLD LEXINGTON RD, WINSTON SALEM, NC 27107-6822
(336) 843-0282
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
NC
Other
Enumeration date
03/23/2026
Last updated
03/27/2026
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