Provider Demographics
NPI:1568555092
Name:JERRY PINKERTON,MD PA
Entity Type:Organization
Organization Name:JERRY PINKERTON,MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-838-9553
Mailing Address - Street 1:1915 WEST PARK DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659
Mailing Address - Country:US
Mailing Address - Phone:336-838-9553
Mailing Address - Fax:336-838-9563
Practice Address - Street 1:1915 WEST PARK DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-838-9553
Practice Address - Fax:336-838-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013CGMedicaid
NC013CGOtherBCBS #
NC89013CGMedicaid
NC013CGOtherBCBS #