MEDICARE: DR. JENNIFER ANN MOCK M.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	207V00000X	Obstetrics & Gynecology Physician	2010-00243	NC

General Provider Information

NPI Number	:	1639252026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ANN MOCK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-2021
Fax Number	:	704-316-2025

Provider Business Practice Location Address
First Line	:	6488 WEDDINGTON-MONROE ROAD
Second Line	:
City	:	WESLEY CHAPEL
State	:	NC
Zip	:	28104
Country	:	US
Telephone Number	:	704-384-1020
Fax Number	:	704-384-1021

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	10/25/2020

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