Individual
JEROME EDWIN JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 WESTGATE CENTER DR, SUITE B, WINSTON SALEM, NC 27103-3040
(336) 765-1571
(336) 659-0425
Mailing address
1345 WESTGATE CENTER DR, SUITE B, WINSTON SALEM, NC 27103-3040
(336) 765-1571
(336) 659-0425
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
17013
NC
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
17013
NC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
17013
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223770001
MEDICARE DME
NC
01
—
45906
BCBSNC
NC
05
—
8945906
—
NC
Enumeration date
05/23/2005
Last updated
02/18/2013
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