Provider Demographics
NPI:1417620527
Name:KAIROS WELLNESS INITIATIVE
Entity type:Organization
Organization Name:KAIROS WELLNESS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:IKWECHEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-293-4107
Mailing Address - Street 1:3000 BETHESDA PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:336-293-4107
Mailing Address - Fax:949-577-4324
Practice Address - Street 1:3000 BETHESDA PL STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3324
Practice Address - Country:US
Practice Address - Phone:336-293-4107
Practice Address - Fax:949-577-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790385326OtherLEILONI MULLIGAN
NC1881108009OtherCHUE BLACK
NC1952582967OtherOBINNA IKWECHEGH
NC1346268745OtherCHARLES DUNHAM