Healthcare Provider Details

I. General information

NPI: 1831363399
Provider Name (Legal Business Name): JESSICA MARIE SLOAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 N BROAD ST E
ANGIER NC
27501-8964
US

IV. Provider business mailing address

PO BOX 2778
LILLINGTON NC
27546-2778
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-2641
  • Fax: 910-893-3208
Mailing address:
  • Phone: 910-893-2641
  • Fax: 910-893-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011-01008
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: