Free National NPI Number Registry
Jerome Edwin Jennings
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NPI Number Detailed Information
Provider Information:
| Name: | Jerome Edwin Jennings |
| Gender: | M |
| Provider License Number If Given: | 17013 |
NPI Information:
| NPI: | 1861495806 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 2/18/2013 |
Provider Business Mailing Address:
| Address: | 1345 WESTGATE CENTER DR SUITE B Winston Salem, NC 27103 |
| Phone Number: | 3367651571 |
| Fax Number: | 3366590425 |
Provider Business Practice Location Address:
| Address: | 1345 WESTGATE CENTER DR SUITE B Winston Salem, NC 27103 |
| Phone Number: | 3367651571 |
| Fax Number: | 3366590425 |
Provider Taxonomy:
| Primary: | 207X00000X |
| Secondary (if any): | 207XS0114X |
| State: | NC |
