MEDICARE: DR. MOHAMED JELLAZI MD

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	390200000X	Student in an Organized Health Care Education/Training Program		NC

General Provider Information

NPI Number	:	1255013827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED JELLAZI MD

Provider Business Mailing Address
First Line	:	2100 STANTONSBURG RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2818
Country	:	US
Telephone Number	:	252-847-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 CURTIS ELLIS DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2298
Country	:	US
Telephone Number	:	252-962-8000
Fax Number	:	252-962-8000

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	05/25/2026

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