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General NPI Number Information
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NPI Number | 1821042235
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Entity Type | Organization
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Legal Business Name | GLENN E. JENNINGS, M.D., P.A.
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 2307 W CONE BLVD STE 130
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City | GREENSBORO
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State | NC
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Zip | 27408-4027
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Country | US
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Telephone | 336-282-3845
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Fax | 336-282-3846
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Provider Business Mailing Address
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Address Line | 2307 W CONE BLVD STE 130
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City | GREENSBORO
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State | NC
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Zip | 27408-4027
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Country | US
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Telephone | 336-282-3845
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Fax | 336-282-3846
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN EARL JENNINGS
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Credential | M.D.
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Telephone | 336-282-3845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NC
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