Healthcare Provider Details

I. General information

NPI: 1255013827
Provider Name (Legal Business Name): MOHAMED JELLAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2298
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-962-8000
  • Fax: 252-962-8000
Mailing address:
  • Phone: 252-847-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRTL23-1159
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: