Provider Demographics
NPI:1780895623
Name:NG, JENNICA K (MD)
Entity type:Individual
Prefix:
First Name:JENNICA
Middle Name:K
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-0399
Mailing Address - Country:US
Mailing Address - Phone:919-894-2011
Mailing Address - Fax:919-894-7645
Practice Address - Street 1:3333 NC HIGHWAY 242 N
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-7844
Practice Address - Country:US
Practice Address - Phone:919-894-2011
Practice Address - Fax:919-894-7645
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-00898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine