Provider Demographics
NPI:1124167358
Name:JEAN-GRACIA, JOLENE (DO)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:JEAN-GRACIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1614 NC HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8297
Practice Address - Country:US
Practice Address - Phone:919-575-6103
Practice Address - Fax:919-657-5681
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53560Medicare UPIN