Provider Demographics
NPI:1942790373
Name:UDOM, JENNIFER UYEMENAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:UYEMENAM
Last Name:UDOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1331
Mailing Address - Fax:336-698-3814
Practice Address - Street 1:1814 WESTCHESTER DR STE 301
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2025
Practice Address - Fax:336-802-2026
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101272815207R00000X
NC2021-00687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine