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General NPI Number Information
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NPI Number | 1831174028
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Entity Type | Organization
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Legal Business Name | DR. JERNIGAN AND ASSOCIATES, P.A.
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1427 N WESLEYAN BLVD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-1843
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Country | US
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Telephone | 252-977-7197
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Fax | 252-977-7403
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Provider Business Mailing Address
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Address Line | 1427 N WESLEYAN BLVD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804
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Country | US
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Telephone | 252-977-7197
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Fax | 252-977-6756
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD WILLIAMS JERNIGAN JR.
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Credential | DDS
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Telephone | 252-977-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5140
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4913
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License Number State | NC
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