Provider Demographics
NPI:1336217678
Name:LEGGETT, JERRY CURTIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:CURTIS
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1601 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9130
Mailing Address - Country:US
Mailing Address - Phone:252-752-0483
Mailing Address - Fax:252-752-2971
Practice Address - Street 1:2245 STANTONSBURG RD
Practice Address - Street 2:SUITE O
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2868
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2765749Medicare ID - Type Unspecified