Healthcare Provider Details

I. General information

NPI: 1962466631
Provider Name (Legal Business Name): JEFFERS MANN & ARTMAN PEDIATRIC & ADOLESENT MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6678
US

IV. Provider business mailing address

2406 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6678
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-5001
  • Fax: 919-786-5051
Mailing address:
  • Phone: 919-786-5001
  • Fax: 919-786-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA WALKER JEFFERS
Title or Position: ADMINSTRATION
Credential:
Phone: 919-786-5001