MEDICARE: DR. JERRY DAVID SPRIGGS JR. PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4105	NC
2	103T00000X	Psychologist	4105	NC
3	103TC0700X	Clinical Psychologist	6301011883	MI

General Provider Information

NPI Number	:	1164531851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY DAVID SPRIGGS JR. PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-0015
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 KERNERSVILLE MEDICAL PKWY
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-7159
Country	:	US
Telephone Number	:	336-515-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/19/2022

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