Provider Demographics
NPI:1720095904
Name:BILLETT, JEANETTE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:BILLETT
Suffix:
Gender:F
Credentials:MD
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-719-7892
Mailing Address - Fax:336-719-7898
Practice Address - Street 1:694 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3117
Practice Address - Country:US
Practice Address - Phone:336-719-7892
Practice Address - Fax:336-719-7898
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51472207RC0000X, 207RC0000X
NC200001465207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00209635OtherRAILROAD MEDICARE
NC89136XGMedicaid
P00209635OtherRAILROAD MEDICARE
NC136XGOtherBCBS
F30661Medicare UPIN
SCQ01465Medicaid