Individual
JONATHAN PRIVETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 MOYE BLVD, ECU PHYSICIANS BRODY OUTPATIENT CENTER, GREENVILLE, NC 27834-4300
(252) 744-4655
(252) 744-3650
Mailing address
PO BOX 751069, ECU PHYSICIANS, CHARLOTTE, NC 28275-1069
(252) 744-3258
Taxonomy
Speciality
Code
Description
License number
State
207ZF0201X
Forensic Pathology Physician
2008-01686
NC
207ZP0101X
Anatomic Pathology Physician
Primary
2008-01686
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174UW
BCBS
NC
05
—
5922084
—
NC
Enumeration date
05/07/2007
Last updated
03/28/2013
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