Provider Demographics
NPI:1619287182
Name:DOWN EAST FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:DOWN EAST FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MMS, PA-C
Authorized Official - Phone:910-353-1276
Mailing Address - Street 1:306 BRYNN MARR ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7023
Mailing Address - Country:US
Mailing Address - Phone:910-353-1276
Mailing Address - Fax:910-353-0967
Practice Address - Street 1:306 BRYNN MARR ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7023
Practice Address - Country:US
Practice Address - Phone:910-353-1276
Practice Address - Fax:910-353-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care