# NC IMMUNOLOGY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NC IMMUNOLOGY, PC, NC Immunology Allergy and Asthma
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619785920
- **Authorized official:** ANNA M JACKSON (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (704) 873-5055

## Contact information

- **Practice address:** 1414 FERN CREEK DR, STATESVILLE, NC 28625-9376
- **Practice address phone:** (704) 873-5055
- **Practice address fax:** (704) 873-5025
- **Mailing address:** 1414 FERN CREEK DR, STATESVILLE, NC 28625-9376
- **Mailing address phone:** (704) 873-5055
- **Mailing address fax:** (704) 873-5025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | — | Yes |
| 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