Provider Demographics
NPI:1669011565
Name:KAIROS MEDICAL CONSULTING, PLLC
Entity Type:Organization
Organization Name:KAIROS MEDICAL CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-909-5939
Mailing Address - Street 1:3000 BETHESDA PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:336-293-4107
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL STE 104
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-293-4107
Practice Address - Fax:949-577-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC256596OtherNC MEDICAL BOARD PROFESSIONAL CORPORATION CERTIFICATE