Individual
MR. JIMMY WAYNE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.PED
Contact information
Practice address
4500 INDIANA AVE STE 45, WINSTON SALEM, NC 27106-3269
(336) 245-4736
(888) 812-7934
Mailing address
4807 EDINBOROUGH RD, GREENSBORO, NC 27406-8322
(336) 674-6422
(336) 674-2282
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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