Healthcare Provider Details

I. General information

NPI: 1194639153
Provider Name (Legal Business Name): CHRISTOPHER DEWAYNE JACOBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTERVIEW DR STE 102
GREENSBORO NC
27407-3712
US

IV. Provider business mailing address

4407 CROWNE LAKE CIR APT 2A
JAMESTOWN NC
27282-7964
US

V. Phone/Fax

Practice location:
  • Phone: 336-285-5204
  • Fax:
Mailing address:
  • Phone: 743-337-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: