OrganizationActive
Club Haven Family Practice PA
NPI 1922323948 · Family Medicine Physician · Winston Salem, NC
Provider details
- NPI number
- 1922323948
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mary Hatley, Practice Manager(336) 768-9575
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(83/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2801 Lyndhurst Ave
Winston Salem, NC 27103-4109
Phone: (336) 768-9575
Fax: (336) 774-1737
Street-level locationGet directions
Mailing address
2801 Lyndhurst Ave
Winston Salem, NC 27103-4109
Registry dates
- Enumerated
- 2010-04-01
- Last updated
- 2015-04-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.