Provider Demographics
NPI:1043243686
Name:JENNINGS, WINSTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FAISON W MCGOWAN RD
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-8930
Mailing Address - Country:US
Mailing Address - Phone:910-275-0369
Mailing Address - Fax:
Practice Address - Street 1:306 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2908
Practice Address - Country:US
Practice Address - Phone:910-567-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC387202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45914OtherBCBS
NC0350883240OtherME#
NC327665OtherTRICARE
NC5900999Medicaid
NCE0093OtherMEDCOST
NC327665OtherTRICARE
NCE0093OtherMEDCOST