Provider Demographics
NPI:1912543950
Name:JENNINGS, HAROLD
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 GLADYS RD
Mailing Address - Street 2:
Mailing Address - City:GLADYS
Mailing Address - State:VA
Mailing Address - Zip Code:24554-2907
Mailing Address - Country:US
Mailing Address - Phone:434-941-8207
Mailing Address - Fax:434-283-1301
Practice Address - Street 1:731 GLADYS RD
Practice Address - Street 2:
Practice Address - City:GLADYS
Practice Address - State:VA
Practice Address - Zip Code:24554-2907
Practice Address - Country:US
Practice Address - Phone:434-941-8207
Practice Address - Fax:434-283-1301
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)