Provider Demographics
NPI:1194733097
Name:JERNIGAN, GEORGE PERRY II (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PERRY
Last Name:JERNIGAN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PARKWOOD MEDICAL PK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621
Mailing Address - Country:US
Mailing Address - Phone:336-835-7113
Mailing Address - Fax:
Practice Address - Street 1:320 PARKWOOD MEDICAL PK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621
Practice Address - Country:US
Practice Address - Phone:333-835-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7994562Medicaid