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General NPI Number Information
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NPI Number | 1861495806
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Entity Type | Individual
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Provider Name | JEROME EDWIN JENNINGS MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1345 WESTGATE CENTER DR SUITE B
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3040
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Country | US
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Telephone | 336-765-1571
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Fax | 336-659-0425
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Provider Business Mailing Address
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Address Line | 1345 WESTGATE CENTER DR SUITE B
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3040
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Country | US
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Telephone | 336-765-1571
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Fax | 336-659-0425
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 17013
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17013
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 17013
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License Number State | NC
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