Healthcare Provider Details

I. General information

NPI: 1902078397
Provider Name (Legal Business Name): MICHAEL JENNINGS JEFFERY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1321 NEW GARDEN RD
GREENSBORO NC
27410-2722
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7868
  • Fax:
Mailing address:
  • Phone: 336-299-0099
  • Fax: 336-299-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102949
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number102949
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: