Healthcare Provider Details

I. General information

NPI: 1578523916
Provider Name (Legal Business Name): JASON DOUGLAS CREEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WESTGATE PLZ
FRANKLIN NC
28734-1422
US

IV. Provider business mailing address

PO BOX 1209
FRANKLIN NC
28744-0569
US

V. Phone/Fax

Practice location:
  • Phone: 828-369-4236
  • Fax: 828-369-0753
Mailing address:
  • Phone: 828-213-1500
  • Fax: 828-651-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNC200401044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: