Healthcare Provider Details

I. General information

NPI: 1740441286
Provider Name (Legal Business Name): ADAM R. JAFFE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3070
  • Fax:
Mailing address:
  • Phone: 336-832-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number55663-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: