Individual
FREEMAN RANDOLPH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1331 N ELM ST, SUITE 200, GREENSBORO, NC 27401-6302
(336) 274-9617
(336) 482-2177
Mailing address
1331 N ELM ST, SUITE 200, GREENSBORO, NC 27401-6302
(336) 274-9617
(336) 482-2177
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22747
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600271
UNITED HEALTHCARE
NC
01
—
23519
PARTNERS
NC
01
—
300085677
RAILROAD MEDICARE
NC
01
—
45552
BLUE CROSS BLUE SHIELD
NC
01
—
73479
MEDCOST
NC
05
—
8945552
—
NC
Enumeration date
11/23/2005
Last updated
10/15/2014
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