Provider Demographics
NPI:1386934933
Name:TURRENTINE, JAKE EVERETT (MD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:EVERETT
Last Name:TURRENTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 TATE BLVD SE STE 2110
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-328-4449
Mailing Address - Fax:
Practice Address - Street 1:1899 TATE BLVD SE STE 2110
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-328-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072838207N00000X
FLME121327207N00000X
SC37485207N00000X
TXP8091207N00000X
NC2016-02183207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA072838OtherGA LICENSES