Individual
FREEMAN R JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 GREEN VALLEY ROAD, SUITE 304, GREENSBORO, NC 27408
(336) 282-4840
Mailing address
600 GREEN VALLEY ROAD, 304, GREENSBORO, NC 27408
(336) 282-4840
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2009-00104
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00969101
RAILROAD-MEDICARE
NC
Enumeration date
04/12/2007
Last updated
11/21/2011
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