Basic Information
| Provider Information | |||||||||
| NPI: | 1245223379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAY | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68 | ||||||||
| Address2: | |||||||||
| City: | POLLOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285730068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331010 | ||||||||
| FaxNumber: | 2522243071 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 MEDICAL LANE | ||||||||
| Address2: | |||||||||
| City: | POLLOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331010 | ||||||||
| FaxNumber: | 2522243071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 73 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 100637 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 11729 | 01 | NC | BLUE CROSS | OTHER | 8911729 | 05 | NC | MEDICAID |