Provider Demographics
NPI:1629320213
Name:SUMERLIN, JEFFERY QUINN (HIS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:QUINN
Last Name:SUMERLIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 FOREST HILLS RD W
Mailing Address - Street 2:WESTWOOD VILLAGE
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3416
Mailing Address - Country:US
Mailing Address - Phone:252-991-5067
Mailing Address - Fax:252-991-5067
Practice Address - Street 1:2328 FOREST HILLS RD W
Practice Address - Street 2:WESTWOOD VILLAGE
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3416
Practice Address - Country:US
Practice Address - Phone:252-991-5067
Practice Address - Fax:252-991-5067
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist