Provider Demographics
NPI:1861859654
Name:EADS, JAMIE KNOX (HIS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:KNOX
Last Name:EADS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2918
Mailing Address - Country:US
Mailing Address - Phone:336-765-1990
Mailing Address - Fax:336-765-1993
Practice Address - Street 1:1313 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2918
Practice Address - Country:US
Practice Address - Phone:336-765-1990
Practice Address - Fax:336-765-1993
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1473237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1473OtherNORTH CAROLINA STATE HEARING AID DEALERS AND FITTER BOARD