Provider Demographics
NPI:1104500453
Name:POOLE, JANELLA ROSE
Entity type:Individual
Prefix:
First Name:JANELLA
Middle Name:ROSE
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W FAIRGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-3258
Mailing Address - Country:US
Mailing Address - Phone:910-975-5493
Mailing Address - Fax:
Practice Address - Street 1:317 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5838
Practice Address - Country:US
Practice Address - Phone:910-220-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21314842347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle