Provider Demographics
NPI:1184590762
Name:LITTLE, JEFFREY STEWART
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEWART
Last Name:LITTLE
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:PO BOX 4837
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4837
Mailing Address - Country:US
Mailing Address - Phone:704-641-1234
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE PARK RD STE 104
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4818
Practice Address - Country:US
Practice Address - Phone:704-360-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies