Provider Demographics
NPI:1326149469
Name:JENNINGS, WILLIAM THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:JENNINGS
Suffix:
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:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:794 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-4074
Practice Address - Country:US
Practice Address - Phone:336-904-2317
Practice Address - Fax:336-443-6030
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062868207Q00000X
DCMD035401207Q00000X
NC2015-01811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD03540OtherLICENSE NUMBER
NC2015-01811OtherLICENSE NUMBER
1346494234OtherBUSINESS NPI
MDD0062868OtherLICENSE NUMBER
MDM57483OtherCDS NUMBER
MDM57483OtherCDS NUMBER
DCMD03540OtherLICENSE NUMBER