Healthcare Provider Details

I. General information

NPI: 1417646530
Provider Name (Legal Business Name): KORY REED JANSMA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-5000
  • Fax:
Mailing address:
  • Phone: 910-671-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number113481
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: