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General NPI Number Information
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NPI Number | 1023955267
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Entity Type | Individual
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Provider Name | JONTA ELLIOTT
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Gender | Male
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 301 S CHURCH ST STE 140I
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-5755
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Country | US
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Telephone | 252-765-4186
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Fax | 252-370-1575
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Provider Business Mailing Address
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Address Line | 524 LAKELAND ST
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City | DURHAM
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State | NC
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Zip | 27701-4508
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Country | US
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Telephone | 843-439-2472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 346094
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License Number State | NC
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