1831174028 NPI number — DR. JERNIGAN AND ASSOCIATES, P.A.

Table of content: (NPI 1831174028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831174028 NPI number — DR. JERNIGAN AND ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JERNIGAN AND ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRS. JERNIGAN, DAVIS AND ASSOCIATES, PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831174028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1427 N WESLEYAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-977-7197
Provider Business Mailing Address Fax Number:
252-977-6756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1427 N WESLEYAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-977-7197
Provider Business Practice Location Address Fax Number:
252-977-7403
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JERNIGAN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
WILLIAMS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-977-7197

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4913 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 5140 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5140 . This is a "DR DAVIS DENTAL LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8992091 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4913 . This is a "DR JERNIGAN DENTAL LIC#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8994578 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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