Individual
GIA ANNALISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
131 MILLER ST, WINSTON SALEM, NC 27103-2508
(336) 716-8092
(336) 716-8018
Mailing address
MEDICAL CENTER BOULEVARD, WINSTON SALEM, NC 27157-0001
(478) 365-2129
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/19/2025
Last updated
03/26/2026
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