Individual
STALEY THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2934 N ELM ST STE B1, LUMBERTON, NC 28358-2986
(910) 272-1175
(910) 272-1176
Mailing address
2002 N CEDAR ST STE B, LUMBERTON, NC 28358-3926
(910) 272-3048
(910) 738-3764
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
38362
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45569
BCBS
NC
05
—
7945569
—
NC
Enumeration date
04/10/2006
Last updated
11/03/2020
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