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General NPI Number Information
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NPI Number | 1326867938
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Entity Type | Organization
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Legal Business Name | INNER BANKS PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 314 W QUEEN ST
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City | EDENTON
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State | NC
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Zip | 27932-1733
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Country | US
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Telephone | 252-302-1526
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N GRANVILLE ST
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City | EDENTON
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State | NC
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Zip | 27932-1823
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Country | US
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Telephone | 252-518-1074
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Fax | 833-605-4108
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Authorized Official
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Title or Position | CEO
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Name | DR. JEAN CLAUDE JUBERT
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Credential | MD
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Telephone | 252-518-1074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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