Provider Demographics
NPI:1710929088
Name:EPILEPSY INSTITUTE OF NC
Entity Type:Organization
Organization Name:EPILEPSY INSTITUTE OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-659-8202
Mailing Address - Street 1:1311 WESTBROOK PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1327
Mailing Address - Country:US
Mailing Address - Phone:336-659-8202
Mailing Address - Fax:336-659-8206
Practice Address - Street 1:1311 WESTBROOK PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1327
Practice Address - Country:US
Practice Address - Phone:336-659-8202
Practice Address - Fax:336-659-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC319452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty