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Individual

MR. GLENN E JENNINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
445 DOLLEY MADISON RD STE 410, GREENSBORO, NC 27410-5167
(336) 292-1510
(336) 292-0679
Mailing address
445 DOLLEY MADISON RD STE 410, GREENSBORO, NC 27410-5167
(336) 292-1510
(336) 292-0679

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
200401076
NC
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2004-01076
NC
2084P0804X
Child & Adolescent Psychiatry Physician
200401076
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1371F
BCBS NC
NC
01
343712
MANAGED HEALTH NETWORK
NC
01
7654624
AETNA
NC
05
891371F
NC
01
D6763
MEDCOST
NC
Enumeration date
05/30/2006
Last updated
07/27/2020
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