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General NPI Number Information
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NPI Number | 1649126723
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Entity Type | Individual
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Provider Name | JEFFERSON RAY IV MA
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Gender | Male
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 261 POPLAR BRANCH RD
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City | POPLAR BRANCH
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State | NC
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Zip | 27965-9745
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Country | US
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Telephone | 252-453-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1347 WATERLILY RD
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City | COINJOCK
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State | NC
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Zip | 27923-9740
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Country | US
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Telephone | 252-619-4399
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8249
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License Number State | NC
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