Individual
DR. JACKIE SMALLS
Active
Individual
DR. JACKIE SMALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2018-02169
NC
207R00000X
Internal Medicine Physician
85218
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164801098
—
NC
01
—
19YU8
BCBS OF NC
NC
05
—
852189
—
SC
01
—
NN42610322
MEDICARE
NC
01
—
SCJ2035019
MEDICARE PIN
SC
01
—
SCJ2039068
MEDICARE PIN
SC
Enumeration date
05/26/2015
Last updated
03/03/2021
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