Healthcare Provider Details

I. General information

NPI: 1609798461
Provider Name (Legal Business Name): JACK FRANCIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WINDSOR GREEN DR
CLAYTON NC
27527-6087
US

IV. Provider business mailing address

143 WINDSOR GREEN DR
CLAYTON NC
27527-6087
US

V. Phone/Fax

Practice location:
  • Phone: 919-817-0674
  • Fax:
Mailing address:
  • Phone: 919-817-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: