Provider Demographics
NPI:1326858036
Name:HINTON, JESSE DEMETRIUS
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:DEMETRIUS
Last Name:HINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 WAYNE WHITE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-8157
Mailing Address - Country:US
Mailing Address - Phone:910-273-1169
Mailing Address - Fax:
Practice Address - Street 1:1111 GORRELL ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1904
Practice Address - Country:US
Practice Address - Phone:336-291-8333
Practice Address - Fax:336-233-2234
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-7463-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist