Provider Demographics
NPI:1770873028
Name:JERNIGAN, PETER LESLIE (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:LESLIE
Last Name:JERNIGAN
Suffix:
Gender:M
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 2345
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2345
Mailing Address - Country:US
Mailing Address - Phone:256-235-5015
Mailing Address - Fax:256-231-2841
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-235-5064
Practice Address - Fax:256-235-5945
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL41527208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery