Provider Demographics
NPI:1962848606
Name:TOWNS, JERRY CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:CHRISTOPHER
Last Name:TOWNS
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 1:113 ANTIQUE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-9351
Mailing Address - Country:US
Mailing Address - Phone:910-797-9053
Mailing Address - Fax:
Practice Address - Street 1:113 ANTIQUE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-9351
Practice Address - Country:US
Practice Address - Phone:910-797-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21171347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle