Provider Demographics
NPI:1700026127
Name:PINN, WALDA STACIA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDA
Middle Name:STACIA
Last Name:PINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-378-1110
Mailing Address - Fax:
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-378-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology