Provider Demographics
NPI:1477675676
Name:JEFFERSON, ANNA BOYD (AO)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BOYD
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:AO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5934
Mailing Address - Country:US
Mailing Address - Phone:336-228-7877
Mailing Address - Fax:336-228-7514
Practice Address - Street 1:420 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5934
Practice Address - Country:US
Practice Address - Phone:336-228-7877
Practice Address - Fax:336-228-7514
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0494IOtherBLUE CROSS BLUE SHIELD
NC7704513Medicaid