Provider Demographics
NPI:1780602185
Name:MCKINNEY, JOHN J JR (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MCKINNEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:711 NATIONAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2668
Practice Address - Country:US
Practice Address - Phone:336-475-2000
Practice Address - Fax:336-475-2008
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110210894OtherRR MEDICARE
NC8957162Medicaid
NC8957162Medicaid
NC2401159Medicare PIN