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General NPI Number Information
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NPI Number | 1962915777
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Entity Type | Individual
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Provider Name | BENJAMIN L JORGENSEN
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Gender | Male
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 801 TILGHMAN DR STE A
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City | DUNN
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State | NC
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Zip | 28334-4958
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Country | US
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Telephone | 910-892-6500
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Fax | 910-892-1766
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | FAISON
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State | NC
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Zip | 28341-0187
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Country | US
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Telephone | 910-267-2042
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Fax | 855-996-9090
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7943
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-14498
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License Number State | NC
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