Provider Demographics
NPI:1114163292
Name:MAYBERRY, JERRI GOLDSTON (MED, RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:GOLDSTON
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:MED, RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HAMBY RD
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-8471
Mailing Address - Country:US
Mailing Address - Phone:336-401-8456
Mailing Address - Fax:336-401-8468
Practice Address - Street 1:118 HAMBY RD
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8471
Practice Address - Country:US
Practice Address - Phone:336-401-8456
Practice Address - Fax:336-401-8468
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered