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Organization
NC IMMUNOLOGY, PC
Active
Organization
NC IMMUNOLOGY, PC
Active
Other names
NC IMMUNOLOGY, PC, NC Immunology Allergy and Asthma
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA M JACKSON (OFFICE ADMINISTRATOR)
(704) 873-5055
Entity
Organization
Contact information
Practice address
1414 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 873-5055
(704) 873-5025
Mailing address
1414 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 873-5055
(704) 873-5025
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
NULL
207K00000X
Allergy & Immunology Physician
Primary
—
—
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207RR0500X
Rheumatology Physician
—
NULL
207RR0500X
Rheumatology Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
Other
Enumeration date
12/19/2024
Last updated
09/23/2026
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