Provider Demographics
NPI:1982683587
Name:BIRDSONG, JEANNE L (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:BIRDSONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:311 N 2ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3995
Mailing Address - Country:US
Mailing Address - Phone:910-763-3034
Mailing Address - Fax:910-251-7859
Practice Address - Street 1:311 N 2ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3995
Practice Address - Country:US
Practice Address - Phone:910-763-3034
Practice Address - Fax:910-251-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004003002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2035202AMedicare ID - Type Unspecified
NCH43691Medicare UPIN