Individual
DR. JACKIE SMALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
521 MOYE BLVD, GREENVILLE, NC 27834
(252) 744-3229
(252) 744-3924
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
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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