Healthcare Provider Details

I. General information

NPI: 1750525416
Provider Name (Legal Business Name): JACOB J STINSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

1719 CLARENDON DR
GREENSBORO NC
27410-2928
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-3200
  • Fax: 336-890-3290
Mailing address:
  • Phone: 207-217-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2187
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2012-01185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: