Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0968 | NC |
Y | 103TC0700X | Clinical Psychologist | 0968 | NC |
NPI | 1003039736 |
---|---|
Provider Name | Dr. Jerry W Noble |
First Address | Winston Salem, NC 27104-4225 |
Second Address | Winston Salem, NC 27104-4225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |