Individual provider Active NPI

Vanessa Kristen Ajizian, MD

  • Pediatrics Physician
  • Kernersville, NC
National Provider Identifier
1629002910
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2006-00408 Issued in NC
Practice address
240 Broad St
Kernersville, NC 27284-2930
Phone
(336) 993-8333
Fax
(336) 993-5144
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2006-00408 NC Primary

Addresses

Primary practice location

240 Broad St
Kernersville, NC 27284-2930

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

301 E Wendover Ave Ste 400
Greensboro, NC 27401-1207
Phone (336) 832-3150

Other identifiers 1

IdentifierTypeStateIssuer
5904913MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vajizian16441@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070130000343 NC Practitioner - Pediatric Medicine 5193726495 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2006-00408NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group LLC Pediatrics CurrentSince May 22, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 22, 2023 Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

517 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 384-1406

1351 Westgate Center Dr
Winston Salem, NC 27103
Phone (336) 718-7777

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1629002910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 BROAD ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842930",
            "telephone_number": "336-993-8333",
            "fax_number": "336-993-5144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 E Wendover Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011207",
            "country_code": "US",
            "telephone_number": "336-832-3150",
            "fax_number": "336-832-3151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AJIZIAN",
        "first_name": "VANESSA",
        "middle_name": "KRISTEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2006-00408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904913",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vajizian16441@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "240 Broad St",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.