Club Haven Family Practice
NPI #1902869829 in Winston-Salem, North Carolina
Provider Information
- NPI Number
- 1902869829
- Entity Type
- Organization
- Organization Name
- Club Haven Family Practice
- Primary Specialty
- Specialist
- Enumeration Date
- Apr 11, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 2801 LYNDHURST AVE
- City
- Winston-Salem
- State
- North Carolina
- ZIP Code
- 27103-4109
- Phone
- (336) 768-9575
Authorized Official
- Name
- DR. THOMAS L. JOLLY, MC
- Title
- OWNER
- Phone
- (336) 768-9575
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist |
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