Provider Demographics
NPI:1821042235
Name:GLENN E. JENNINGS, M.D., P.A.
Entity Type:Organization
Organization Name:GLENN E. JENNINGS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-282-3845
Mailing Address - Street 1:2307 W CONE BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4027
Mailing Address - Country:US
Mailing Address - Phone:336-282-3845
Mailing Address - Fax:336-282-3846
Practice Address - Street 1:2307 W CONE BLVD
Practice Address - Street 2:STE 130
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4027
Practice Address - Country:US
Practice Address - Phone:336-282-3845
Practice Address - Fax:336-282-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center