Provider Demographics
NPI:1316053630
Name:GUILLIAMS, JEANNE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:GUILLIAMS
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 1:3400 CROASDAILE DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6815
Mailing Address - Country:US
Mailing Address - Phone:919-382-0150
Mailing Address - Fax:919-382-3390
Practice Address - Street 1:3400 CROASDAILE DR
Practice Address - Street 2:STE. 201
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6815
Practice Address - Country:US
Practice Address - Phone:919-382-0150
Practice Address - Fax:919-382-3390
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13626OtherBCBS
NC7210504Medicaid
NC13626OtherBCBS