Healthcare Provider Details

I. General information

NPI: 1306462080
Provider Name (Legal Business Name): JOCELYN GABRIELLA BUMPERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CORNWALLIS DR STE O
GREENSBORO NC
27408-7015
US

IV. Provider business mailing address

2100 W CORNWALLIS DR STE O
GREENSBORO NC
27408-7015
US

V. Phone/Fax

Practice location:
  • Phone: 336-337-5469
  • Fax:
Mailing address:
  • Phone: 336-337-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014661
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: