Provider Demographics
NPI:1376622357
Name:JERRETT, JUSTINE GREATHOUSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:GREATHOUSE
Last Name:JERRETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1012 QUIET RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7257
Mailing Address - Country:US
Mailing Address - Phone:919-844-4155
Mailing Address - Fax:
Practice Address - Street 1:3801 LAKE BOONE TRL
Practice Address - Street 2:SUITE 320
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2934
Practice Address - Country:US
Practice Address - Phone:919-784-9182
Practice Address - Fax:919-256-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry