Healthcare Provider Details

I. General information

NPI: 1275649097
Provider Name (Legal Business Name): PEACE NNENNAYA JESSA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HICKSWOOD RD STE 106
HIGH POINT NC
27265-1538
US

IV. Provider business mailing address

4457 STATE ROUTE 159
CHILLICOTHEE OH
45601-8620
US

V. Phone/Fax

Practice location:
  • Phone: 336-885-9675
  • Fax: 336-885-9682
Mailing address:
  • Phone: 740-779-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number34.010580
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number01737
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: