MEDICARE: GOLDSBORO SKIN CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	27212	NC
2	207ND0900X	Dermatopathology Physician	27212	NC
3	207N00000X	Dermatology Physician	27212	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972567634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDSBORO SKIN CENTER PA

Provider Business Mailing Address
First Line	:	2613 HOSPITAL RD
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9424
Country	:	US
Telephone Number	:	919-736-0222
Fax Number	:	919-736-0223

Provider Business Practice Location Address
First Line	:	2613 HOSPITAL RD
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9424
Country	:	US
Telephone Number	:	919-736-0222
Fax Number	:	919-736-0223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L JENNINGS JR.
Credential	:	MD
Telephone Number	:	919-736-0222

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	09/11/2025

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