Individual
JACKIE REX FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20036 ZION AVE, STE 100, CORNELIUS, NC 28031-8435
(704) 801-7400
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200100232
NC
Other
Enumeration date
07/13/2006
Last updated
07/15/2024
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