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General NPI Number Information
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NPI Number | 1326858036
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Entity Type | Individual
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Provider Name | JESSE DEMETRIUS HINTON
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Gender | Male
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1111 GORRELL ST
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City | GREENSBORO
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State | NC
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Zip | 27406-1904
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Country | US
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Telephone | 336-291-8333
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Fax | 336-233-2234
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Provider Business Mailing Address
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Address Line | 2774 WAYNE WHITE RD
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City | PLEASANT GARDEN
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State | NC
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Zip | 27313-8157
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Country | US
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Telephone | 910-273-1169
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 2020-7463-01
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License Number State | NC
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