Healthcare Provider Details

I. General information

NPI: 1972567634
Provider Name (Legal Business Name): GOLDSBORO SKIN CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 HOSPITAL RD
GOLDSBORO NC
27534-9424
US

IV. Provider business mailing address

2613 HOSPITAL RD
GOLDSBORO NC
27534-9424
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-0222
  • Fax: 919-736-0223
Mailing address:
  • Phone: 919-736-0222
  • Fax: 919-736-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number27212
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number27212
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27212
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN L JENNINGS JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 919-736-0222